Introduction: Cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure with reduced ejection fraction and normal sinus rhythm. However, its role in patients with pacing indication, narrow QRS, and normal ejection fraction remains controversial. Objectives: We aimed to evaluate the impact of biventricular pacing (BiV) versus conventional right ventricular (RV) pacing (DDD mode, ventricular pacing avoidance algorithm) in patients with normal ejection fraction. Methods: A comprehensive literature search in PubMed, Google Scholar, and Cochrane Review from inception to November 15, 2020, was performed. Outcomes studies were - major adverse cardiovascular events (MACE, composite of cardiovascular death, hospitalization for heart failure or any cardiovascular cause), cardiovascular mortality, change in left ventricular ejection fraction (LVEF, %), left ventricular end-systolic volume (LVESV, mL) and left ventricular end-diastolic volume (LVEDV, mL). Results: Four randomized trials (n=457, BiV group=229, mean age 71.6±4.4 years, RV pacing=228, mean age 70.3±4.38 years) met inclusion criteria. There was a significant reduction in MACE (RR 0.68, 95% CI 0.46-0.99, p=0.04), LVESV [mean difference (MD) -6.42, 95%CI -10.27- -2.57; p=0.001], LVEDV (MD -6.12,95% CI -9.30 to -2.94; p=0.0002) in patients with BiV pacing compared to RV pacing. There was no reduction in cardiovascular mortality and a trend towards improvement in LVEF (MD 3.99,95% -0.12-8.10; p=0.06) with BiV pacing compared to RV pacing during the follow-up period (1.95 years). Conclusion: BiV pacing may be a feasible option for permanent pacing in patients with normal LVEF and may attenuate untoward effects of conventional RV pacing on the left ventricular function.