Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
Outcomes of conduction system and right ventricular pacing in bradyarrhythmia indications: A systematic review and meta-analysis of propensity-score matched and randomized studies.
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Toni George Khairallah Terezia, Faizollah Zadeh Ardebili Saman, Dandamudi Mrunalini, Pinilla Juan, Hakkeem Bezalel, Schettino Samad Nathalia, de Paula Portilho Natanael, Casillas-Munoz Juan P, Čurila Karol, Sedláček Kamil
Аннотация
BACKGROUND: Evidence supporting the use of conduction system pacing (CSP) in bradycardia is currently predominantly based on observational data. We performed a meta-analysis of recent propensity-score matched (PSM) studies and randomized controlled trials (RCTs) evaluating outcomes of CSP and right ventricular pacing (RVP) in bradycardia indications.
METHODS: We systematically searched three databases for eligible studies. Risk ratios (RRs) and mean differences (MDs) with their 95% confidence intervals (CI) were pooled using a random-effects model. Subgroup analyses of RCTs were performed for key outcomes.
RESULTS: Fifteen studies (8 RCTs, 7 PSM) comprising 6,064 patients were included. Compared to RVP, CSP significantly reduced heart failure hospitalizations (RR:0.31; 95% CI:0.21-0.46; p < 0.001) and the need for cardiac resynchronization therapy (CRT) upgrades (RR:0.31; 95% CI:0.12-0.78; p = 0.01), while modestly improving left ventricular ejection fraction (MD:3.98%; 95% CI:2.22-5.74; p < 0.001) and resulting in narrower QRS durations (MD:-27.3 ms; 95% CI:-35.9 to -18.6; p < 0.001). These findings were consistent in sub-analyses of RCTs. CSP was associated with reduction of all-cause mortality in the overall analysis (RR:0.51; 95% CI:0.34-0.78; p = 0.002), but not in the RCT and PSM subgroups. No significant differences between groups were observed for cardiovascular mortality (RR:0.49; 95% CI:0.23-1.04; p = 0.06), procedural complications, or atrial fibrillation. CSP was associated with longer procedural and fluoroscopy times.
CONCLUSION: CSP significantly reduces the risk of heart failure hospitalizations and the need for CRT upgrades compared to RVP in patients with bradycardia indications. Ongoing, large-scale RCTs are needed to verify the effect of CSP on mortality and its long-term safety.
METHODS: We systematically searched three databases for eligible studies. Risk ratios (RRs) and mean differences (MDs) with their 95% confidence intervals (CI) were pooled using a random-effects model. Subgroup analyses of RCTs were performed for key outcomes.
RESULTS: Fifteen studies (8 RCTs, 7 PSM) comprising 6,064 patients were included. Compared to RVP, CSP significantly reduced heart failure hospitalizations (RR:0.31; 95% CI:0.21-0.46; p < 0.001) and the need for cardiac resynchronization therapy (CRT) upgrades (RR:0.31; 95% CI:0.12-0.78; p = 0.01), while modestly improving left ventricular ejection fraction (MD:3.98%; 95% CI:2.22-5.74; p < 0.001) and resulting in narrower QRS durations (MD:-27.3 ms; 95% CI:-35.9 to -18.6; p < 0.001). These findings were consistent in sub-analyses of RCTs. CSP was associated with reduction of all-cause mortality in the overall analysis (RR:0.51; 95% CI:0.34-0.78; p = 0.002), but not in the RCT and PSM subgroups. No significant differences between groups were observed for cardiovascular mortality (RR:0.49; 95% CI:0.23-1.04; p = 0.06), procedural complications, or atrial fibrillation. CSP was associated with longer procedural and fluoroscopy times.
CONCLUSION: CSP significantly reduces the risk of heart failure hospitalizations and the need for CRT upgrades compared to RVP in patients with bradycardia indications. Ongoing, large-scale RCTs are needed to verify the effect of CSP on mortality and its long-term safety.