Conduction system pacing significantly reduced the risk of the primary composite outcome (RR 0.44) and all-cause mortality (RR 0.50) compared to right ventricular pacing in atrioventricular block.
Meta-Analysis (n=5,390)
Yes
Does conduction system pacing reduce adverse clinical outcomes and improve ventricular function compared to right ventricular pacing in patients with atrioventricular block?
Conduction system pacing is associated with lower mortality, reduced heart failure hospitalizations, and improved left ventricular function compared to traditional right ventricular pacing in patients with AV block.
Effect estimate: RR 0.44 (95% CI 0.35-0.55)
p-value: p=<0.0001
Abstract Introduction Right ventricular pacing (RVP) is the conventional treatment for atrioventricular (AV) block, but may cause ventricular dyssynchrony and adverse remodeling. Conduction system pacing (CSP) has emerged as a physiologic alternative. This meta-analysis compared the efficacy, safety, echocardiographic, and electrical outcomes of CSP versus RVP in patients with AV block. Methods From 2,688 records identified in PubMed, Cochrane, Embase, and ScienceDirect, 19 studies were included. Pooled efficacy, safety, echocardiographic, and procedural outcomes were analyzed using a random-effects model in R (v4.5.1), with meta-regression assessing follow-up effects; p < 0.05 was considered significant. Results Nineteen studies comprising 5,390 patients (2,182 CSP; 3,208 RVP) were analyzed. Compared with RVP, CSP was associated with a reduction in all-cause mortality (RR 0.50, p < 0.0001), heart failure hospitalization (RR 0.39, p < 0.0001), pacing-induced cardiomyopathy (RR 0.36, p = 0.039), and the primary composite outcome (RR 0.44, p < 0.0001). Cardiovascular death, cardiac resynchronization therapy upgrade, and biventricular pacing upgrade did not differ significantly between groups. CSP was associated with improved left ventricular ejection fraction (MD +2.60%, p < 0.0001) and reduced left ventricular end-diastolic diameter (MD −1.54 mm, p < 0.0001) compared with RVP. Shorter paced QRS duration at implantation and follow-up was observed with CSP compared with RVP, indicating superior ventricular synchrony, although procedural and fluoroscopy times were longer. Meta-regression indicated that LVEF improvement decreased with longer follow-up, while LVEDD reduction remained consistent. Conclusion CSP was associated with lower all-cause mortality, HF hospitalization, and pacing-induced cardiomyopathy, while improving ventricular function without additional device-related complications compared with RVP; however, these findings should be interpreted in the context of predominantly observational data.
Ahmed et al. (Wed,) conducted a meta-analysis in Atrioventricular block (n=5,390). Conduction system pacing (CSP) vs. Right ventricular pacing (RVP) was evaluated on Primary composite outcome (RR 0.44, 95% CI 0.35-0.55, p=<0.0001). Conduction system pacing significantly reduced the risk of the primary composite outcome (RR 0.44) and all-cause mortality (RR 0.50) compared to right ventricular pacing in atrioventricular block.