Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Right ventricular pacing (RVP) can lead to adverse cardiac structural and functional changes.
• The potential of physiologic pacing, including biventricular pacing (BiVP) and His bundle pacing (HisBP), to mitigate these effects is not fully understood.

Purpose of the Study:

• To review existing literature and determine if BiVP and/or HisBP prevent adverse remodeling compared to RVP.
• To assess structural, functional, and clinical advantages of BiVP/HisBP over RVP in patients without severe left ventricular dysfunction.

Main Methods:

• A meta-analysis of randomized trials and observational studies was performed.
• Searched MEDLINE (PubMed) and Embase for studies comparing BiVP or HisBP versus RVP.
• Included studies measured left ventricular dimensions, ejection fraction (LVEF), heart failure classification, quality of life, and mortality.

Main Results:

• Eight studies with 679 patients were analyzed.
• Physiologic pacing (BiVP/HisBP) significantly reduced LV volumes and preserved/improved LVEF (mean follow-up 1.57-1.64 years).
• Benefits were more pronounced in patients with LVEF >35% and in those with chronic atrial fibrillation undergoing AV node ablation.

Conclusions:

• BiVP and HisBP preserve or improve LVEF in patients with LVEF >35% compared to RVP.
• Patient-centered clinical outcome improvements are primarily observed in specific patient groups, notably those with chronic atrial fibrillation post-ablation.