Left bundle branch area pacing vs. biventricular pacing significantly improves clinical outcomes and cardiac remodeling in cardiac resynchronization therapy: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Biventricular pacing (BiVP) is the conventional approach for cardiac resynchronization therapy (CRT), yet approximately one-third of patients show no clinical response. Left bundle branch area pacing (LBBAP) enables more physiological ventricular activation through His-Purkinje conduction, but its impact on key clinical endpoints such as all-cause mortality and heart failure hospitalization (HFH) remains debated. Methods: A systematic search of PubMed, Embase, Cochrane Library, and CNKI (to May 3, 2025) identified 24 studies encompassing 6,538 patients. Study quality was assessed using Cochrane RoB 2.0 and the Newcastle-Ottawa Scale. Subgroup analyses (by follow-up duration, study design, and sex), leave-one-out sensitivity analysis, and meta-regression were performed to assess result robustness and heterogeneity sources. Trim-and-fill correction was applied to adjust for potential publication bias. Results: LBBAP was associated with a markedly lower risk compared to BiVP across several clinical outcomes. Specifically, it significantly reduced the risk of the composite endpoint (HR: 0.67, 95% CI: 0.59-0.75), all-cause mortality (HR: 0.83, 95% CI: 0.71-0.96), and HFH (HR: 0.58, 95% CI: 0.50-0.67). Echocardiographic outcomes further supported LBBAP superiority, with higher rates of echocardiographic response (OR: 1.57, 95% CI: 1.36-1.81) and super-response (OR: 2.12, 95% CI: 1.62-2.76). Improvements in left ventricular ejection fraction (LVEF) were greater with LBBAP at both 3-6 months (MD: 5.31%, 95% CI: 4.63-5.99) and ≥12 months (MD: 4.43%, 95% CI: 2.27-6.60). Similarly, left ventricular end-diastolic diameter (LVEDD) reductions were more pronounced at 3-6 months (MD: -3.48 mm, 95% CI: -5.76 to -1.21) and ≥12 months (MD: -2.86 mm, 95% CI: -5.05 to -0.68). Conclusions: These findings indicate that LBBAP provides superior clinical and structural outcomes compared to BiVP in patients undergoing CRT. Large-scale, multicenter randomized controlled trials are warranted to confirm these results, assess long-term efficacy, and elucidate gender-specific variations to optimize evidence-based CRT delivery. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251055488, PROSPERO CRD420251055488.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.028 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".