We thank Romeiro et al for their letter. Although we generally agree with the limited performance of funnel plots when the number of included studies is low, this systematic review and meta-analysis aimed to summarize the totality of published randomized controlled trials on conduction system pacing vs biventricular pacing in patients with heart failure with reduced ejection fraction. This significantly increases the quality of evidence when compared to a prior meta-analysis since observational studies were not included. Moreover, our analysis focuses on surrogate outcomes (ie, QRS duration, left ventricular ejection fraction, and New York Heart Association class) on the basis of studies with small samples. In our article, we emphasized that large, ongoing randomized trials are required to assess clinical outcomes (ie, mortality).