Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block.

Background and

Objectives

The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and more physiological alternative to BVP in these patients. A few small studies studying this question have reported conflicting results. This meta-analysis aims to compare procedural and clinical outcomes between CSP and BVP in this group. Materials and

Methods

An online literature search was systematically conducted to retrieve studies comparing CSP and BVP in HFrEF patients with non-LBBB. Four studies with 461 patients were included.

Results

Implant-derived paced QRS duration was significantly shorter (mean difference [MD] -19.7 ms, 95% confidence interval [CI] -36.2 to -3.3, p = 0.0355) with CSP. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD 5.6%, 95% CI 3.1 to 8.0, p = 0.0106) was also observed with CSP. There were no statistically significant differences in clinical outcomes such as all-cause mortality (relative risk [RR] 0.53, 95% CI 0.18 to 1.60, p = 0.133) and heart failure hospitalization (RR 0.54, 95% CI 0.19 to 1.56, p = 0.129).

Conclusions

This meta-analysis suggests that CSP may have better electrical synchrony and echocardiographic response compared to BVP in HFrEF patients with non-LBBB. Further randomized studies with longer follow-up may be required to elucidate potential benefits in clinical outcomes.