Key result
His bundle pacing or biventricular pacing significantly reduced all-cause mortality (OR 0.66; 95% CI 0.51-0.85; P=0.002) and heart failure hospitalizations compared to right ventricular pacing.
Why the study?
Although right ventricular pacing may impair ventricular function, it remains commonly used for advanced atrioventricular block with normal or mildly reduced ejection fraction.
Does His bundle pacing or biventricular pacing reduce all-cause death and heart failure hospitalizations compared to right ventricular pacing in patients with advanced AVB and normal or mildly reduced EF?
Meta-Analysis (n=2,349)
Does His bundle pacing or biventricular pacing reduce all-cause death and heart failure hospitalizations compared to right ventricular pacing in patients with advanced AVB and normal or mildly reduced EF?
Odds Ratio: 0.66 (95% CI 0.51–0.85)
p-value: p=0.002
His bundle pacing and biventricular pacing are superior to right ventricular pacing in reducing mortality and heart failure hospitalizations in patients with advanced AV block and normal or mildly reduced ejection fraction.
Supports preferring His bundle or biventricular over right ventricular pacing in advanced AV block with preserved EF; confirms mortality benefit in meta-analysis.
INTRODUCTION: Although right ventricular pacing (RVP) may impair ventricular function, it is commonly used for advanced atrioventricular block (AVB) and normal or mildly reduced ejection fraction (EF). We aimed to compare His bundle pacing (HBP), biventricular pacing (BiVP), and RVP for advanced AVB in patients with normal or mildly reduced EF. METHODS AND RESULTS: MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov, Scopus, and Web of Science were searched. Outcomes were all-cause death, heart failure hospitalizations (HFH), EF, left ventricular volumes, 6-minute walk test, and QRS duration. HBP or BiVP was compared with RVP. Subsequently, network meta-analysis compared the three pacing options. Our protocol was registered in PROSPERO (CRD42018094132). Six studies compared BiVP and RVP (704 vs 614 patients) and four compared HBP and RVP (463 vs 568 patients). Follow-up was 6 months to 5 years. There was significantly lower mortality and HFH with HBP or BiVP as compared with RVP (odds ratio [OR], 0.66, [0.51-0.85], P = .002; OR, 0.61 [0.45-0.82], P < .001, respectively]. HBP or BiVP also showed significant increase in EF and decrease in QRS duration (mean difference [MD], 5.27 [3.86-6.69], P < .001; MD -42.2 [-51.2 to -33.3], P < .001, respectively). In network meta-analysis, HBP and BiVP were associated with significantly improved survival compared to RVP, with surface under the cumulative ranking curve (SUCRA) probability of 79.4%, 69.4%, and 1.2% for HBP, BiVP, and RVP, respectively. For HFH, SUCRA probability was 91.5%, 57.2%, and 1.3%, respectively. CONCLUSION: HBP or BiVP were the superior strategies to reduce all-cause death and HFH for advanced AVB with normal or mildly reduced EF, with no significant difference between BiVP and HBP.
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Fernandes et al. (2020) conducted a meta-analysis in Advanced atrioventricular block with normal or mildly reduced ejection fraction (n=2,349). His bundle pacing or biventricular pacing vs. Right ventricular pacing was evaluated on All-cause death (OR 0.66, 95% CI 0.51-0.85, p=0.002). His bundle pacing or biventricular pacing significantly reduced all-cause mortality (OR 0.66; 95% CI 0.51-0.85; P=0.002) and heart failure hospitalizations compared to right ventricular pacing.
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