Large-scale aggregate data for left bundle branch area pacing as first line for CRT: climbing the pyramid of evidence

Graphical Abstract: Meta-analyses are the best piece of evidence we have waiting for large randomized clinical trials. Complexity of the heart failure treatment landscape. Randomization ensures balance between groups and avoids bias in the comparison of treatment groups. ACEi, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor-neprilysin inhibitor; BiV, biventricular; CSP, conduction system pacing; CRT: cardiac resynchronization therapy; HFrEF, heart failure with reduced ejection fraction; HOT-CRT, His bundle pacing combined with coronary venous left ventricular pacing; IVCD, intraventricular conduction delay; LBBB, left bundle branch block; LBBAP, left bundle branch area pacing; LOT-CRT, left bundle branch pacing combined with coronary venous left ventricular pacing; MRA, mineralocorticoid receptor antagonist; SGLT2i, sodium-glucose co-transporter 2 inhibitor (Diaz et al., 2024; Kim et al., 2023; Jin et al., 2023; Yousaf et al., 2023; Tavolinejad et al., 2023; Wang et al., 2023; Ferreira Felix et al., 2024) (Figure presented.)