BMC cardiovascular disorders · 2025
Comparative effects of biventricular and right ventricular pacing on clinical outcomes in atrioventricular block: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Khalid Ayan, Rasool Anas, Daniyal Shaikh Muhammad, Ibrahim Muhammad, Siddiqui Fauzaan Ahmed, Saad Muhammad, Siddiqui Muhammad Hasan, Balach Rahul, Ahmed Hafiz Bilal, Gul Isbah, Adil Yamaan, Tabish Sabula, Ashraf Danish Ali, Sajid Ahmed, Jabarkhil Romal
Аннотация
BACKGROUND: Right ventricular (RV) pacing is the standard treatment for atrioventricular (AV) block but may impair left ventricular (LV) function over time. Biventricular (BiV) pacing offers a physiologic alternative, though prior evidence has been mixed, particularly after the BioPace trial.
METHODS: PubMed, ScienceDirect, Google Scholar, and the Cochrane Library were searched through May 2025 for randomized controlled trials (RCTs) comparing BiV and RV pacing in AV block. Thirteen RCTs (n = 3,685) met the inclusion criteria. Outcomes included heart failure (HF) hospitalization, all-cause mortality, six-minute walk distance (6MWD), cardiovascular (CV) death, and LVEF (%) at follow-up.
RESULTS: BiV pacing significantly reduced HF hospitalizations (risk ratio [RR] = 0.83, 95% CI 0.69-0.98; p = 0.03) and better preserved LVEF (mean difference = 6.17%, 95% CI 3.85-8.49; p < 0.00001). No significant differences were observed in all-cause mortality (RR = 0.87, 95% CI 0.70-1.08; p = 0.21) or CV death (RR = 0.95, 95% CI 0.75-1.21; p = 0.70). RV pacing showed a borderline improvement in 6MWD (mean difference = 10.3 m, 95% CI - 0.1 to 20.7; p = 0.05).
CONCLUSION: In patients with AV block and high pacing burden, BiV pacing reduced HF hospitalizations and better preserved systolic function compared with RV pacing. These findings support a burden-based pacing strategy, while CRT use should be individualized, considering patient profile and procedural factors.
SYSTEMATIC REVIEW REGISTRATION: This systematic review and meta-analysis was retrospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID 1080380.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: PubMed, ScienceDirect, Google Scholar, and the Cochrane Library were searched through May 2025 for randomized controlled trials (RCTs) comparing BiV and RV pacing in AV block. Thirteen RCTs (n = 3,685) met the inclusion criteria. Outcomes included heart failure (HF) hospitalization, all-cause mortality, six-minute walk distance (6MWD), cardiovascular (CV) death, and LVEF (%) at follow-up.
RESULTS: BiV pacing significantly reduced HF hospitalizations (risk ratio [RR] = 0.83, 95% CI 0.69-0.98; p = 0.03) and better preserved LVEF (mean difference = 6.17%, 95% CI 3.85-8.49; p < 0.00001). No significant differences were observed in all-cause mortality (RR = 0.87, 95% CI 0.70-1.08; p = 0.21) or CV death (RR = 0.95, 95% CI 0.75-1.21; p = 0.70). RV pacing showed a borderline improvement in 6MWD (mean difference = 10.3 m, 95% CI - 0.1 to 20.7; p = 0.05).
CONCLUSION: In patients with AV block and high pacing burden, BiV pacing reduced HF hospitalizations and better preserved systolic function compared with RV pacing. These findings support a burden-based pacing strategy, while CRT use should be individualized, considering patient profile and procedural factors.
SYSTEMATIC REVIEW REGISTRATION: This systematic review and meta-analysis was retrospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID 1080380.
CLINICAL TRIAL NUMBER: Not applicable.
Предметные рубрики MeSH
HumansAtrioventricular BlockTreatment OutcomeVentricular Function, LeftCardiac Resynchronization TherapyVentricular Function, RightRisk FactorsFemaleRecovery of FunctionMaleTime FactorsAgedMiddle AgedExercise ToleranceStroke VolumeRandomized Controlled Trials as TopicHeart FailureHospitalizationRisk Assessment