Conduction system pacing vs right ventricular pacing after TAVR: A systematic review and meta-analysis

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Conduction system pacing (CSP), encompassing His bundle pacing and left bundle branch pacing, is an emerging physiological alternative to right ventricular pacing (RVP).
• This approach is particularly relevant for patients experiencing conduction disturbances post-transcatheter aortic valve replacement (TAVR).

Purpose of the Study:

• To conduct a systematic review and meta-analysis comparing the efficacy and safety of CSP versus RVP.
• To evaluate outcomes in patients undergoing TAVR who develop conduction disturbances.

Main Methods:

• A systematic literature search was performed across PubMed, Embase, and Cochrane databases, adhering to PRISMA guidelines.
• A random-effects model was employed for meta-analysis, with heterogeneity assessed using I² statistics.
• The study protocol was registered with PROSPERO (CRD420251125169).

Main Results:

• Analysis of 8 studies involving 784 patients revealed no significant difference in all-cause mortality between CSP (74% left bundle branch pacing) and RVP at 15-month follow-up (OR 0.76; P = .15).
• CSP was associated with significantly shorter paced QRS duration (MD -34.6 ms; P < .001) and improved left ventricular ejection fraction (MD +5.4%; P = .003) at 15 months.
• CSP demonstrated a reduction in heart failure hospitalizations (OR 0.44; P = .006), while cardiovascular mortality, sensing parameters, impedance, and lead dislodgement rates were similar between the groups.

Conclusions:

• CSP facilitates more physiological ventricular activation compared to RVP following TAVR.
• The findings suggest CSP may enhance functional outcomes, including reduced heart failure hospitalizations and improved cardiac function, without compromising survival.
• Further randomized controlled trials are recommended to validate these promising observations regarding CSP in the TAVR population.