Conduction System Pacing Versus Right Ventricular Pacing in Atrioventricular Block: A Systematic Review and...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Right ventricular pacing (RVP) is standard for atrioventricular (AV) block but can cause ventricular dyssynchrony.
• Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), is explored as a physiologic alternative.

Purpose of the Study:

• To evaluate the efficacy and safety of CSP compared to RVP.
• To assess differences in left ventricular ejection fraction (LVEF), QRS duration, procedure time, and complications.

Main Methods:

• Systematic search of randomized controlled trials (RCTs) across major databases.
• Meta-analysis of outcomes using risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).
• Data pooled using a random-effects model in R (version 4.4.2).

Main Results:

• Five RCTs with 659 patients were analyzed.
• CSP significantly improved LVEF (MD: 1.31%) and narrowed paced QRS duration (MD: -28.44 ms) compared to RVP.
• CSP was associated with longer procedure times (MD: 25.86 min) but comparable device/lead complication risks.

Conclusions:

• CSP provides more physiological ventricular activation than RVP.
• CSP offers slight LVEF improvement and significant QRS narrowing with comparable safety.
• CSP is a viable alternative to RVP, balancing efficacy and safety.