Conduction system pacing improved left ventricular ejection fraction by 1.31% and narrowed QRS duration by 28.44 ms compared to right ventricular pacing, without increasing complications.
Does conduction system pacing improve LVEF and QRS duration compared to right ventricular pacing in patients with atrioventricular block?
Conduction system pacing provides more physiological ventricular activation than right ventricular pacing in AV block, slightly improving LVEF and narrowing QRS duration without increasing lead or device complications.
ABSTRACT Introduction Right ventricular pacing (RVP) is the standard therapy for atrioventricular (AV) block but may cause ventricular dyssynchrony with long‐term use. This meta‐analysis evaluates the efficacy and safety of conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP), as a physiologic alternative to RVP. Methods A systematic search was conducted across PubMed, Google Scholar, Cochrane CENTRAL, and ClinicalTrials.gov from inception to August 2025, for randomized controlled trials (RCTs). Outcomes were analyzed as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) and pooled using the Mantel‐Haenszel random‐effects model in R (version 4.4.2). Results Five RCTs enrolling 659 patients were included. CSP was associated with a significant improvement in LVEF compared with RVP (MD: 1.31%; 95% CI: 0.49 to 2.14; p < 0.01). While CSP resulted in a significantly narrower paced QRS duration (MD: –28.44 ms; 95% CI: –38.96 to –17.92; p < 0.01), the procedure time was longer with CSP (MD: 25.86 min; 95% CI: 23.09 to 28.63; p < 0.01). The risk of device and lead‐related complications was comparable between cohorts (RR: 1.35; 95% CI, 0.28 to 6.63; p = 0.71). Conclusion Conduction system pacing (CSP) slightly improves LVEF and achieves a significantly narrower paced QRS compared with right ventricular pacing (RVP). Although associated with longer procedure times, CSP does not increase device‐ or lead‐related complications. These findings suggest that CSP offers more physiological ventricular activation while maintaining comparable safety to conventional RVP. Trial Registration PROSPERO number: CRD420251152303
Daniyal et al. (2026) studied this question. Conduction system pacing improved left ventricular ejection fraction by 1.31% and narrowed QRS duration by 28.44 ms compared to right ventricular pacing, without increasing complications.