Updated Meta‐Analysis of Left Bundle Branch Area Pacing Versus Right Ventricular Pacing in Conduction System Disorders: Insights From New Evidence

Figure 1. PRISMA flow diagram of study selection. The diagram shows the number of records identified, screened, assessed for eligibility, and included in the systematic review and meta‐analysis, with reasons for exclusions at each stage.

Figure 2. Forest plot representing the mean difference in QRS duration from baseline to post‐implantation between left bundle branch area pacing and right ventricular pacing. Negative values indicate a greater reduction in QRS duration with LBBAP compared to RVP.

Figure 3. Forest plot representing the mean difference in left ventricular ejection fraction (LVEF) from baseline to post‐implantation between left bundle branch area pacing and right ventricular pacing. Positive values indicate an increase in LVEF with LBBAP compared to RVP.

Figure 4. Forest plot representing the mean difference in left ventricular end‐diastolic diameter from baseline to post‐implantation between left bundle branch area pacing and right ventricular pacing. Negative values indicate a greater reduction in LVEDD with LBBAP compared to RVP.

Figure 5. Central illustration summarizing the electrical, functional, and procedural outcomes comparing left bundle branch area pacing (LBBAP) with right ventricular pacing (RVP). The figure highlights pooled estimates for electrical parameters (QRS duration and R‐wave amplitude), structural cardiac remodeling outcomes (change in LVEF and LVEDD), and procedural metrics including pacing impedance, pacing threshold, procedural time, and fluoroscopic time. Effect estimates are expressed as mean differences (MD). Positive values indicate an increase with LBBAP relative to RVP, while negative values indicate a decrease.

Figure 6. Central illustration summarizing the procedural safety profile and clinical outcomes comparing left bundle branch area pacing (LBBAP) with right ventricular pacing (RVP). The figure presents pooled risk estimates for procedural complications (lead dislodgement, lead revision, reintervention, septal perforation, pericardial effusion or tamponade, periprocedural mortality, and overall complications) as well as major clinical outcomes including heart failure hospitalization, all‐cause mortality, and change in NT‐proBNP levels. Effect estimates are expressed as risk ratios (RR) or mean differences (MD) with corresponding 95% confidence intervals.