Conduction system pacing versus biventricular cardiac resynchronisation pacing: meta-analysis on procedural outcomes in patients with non-left bundle branch block

Conduction System Pacing has gained significant traction and may provide a safe, more physiological alternative to biventricular cardiac resynchronisation pacing in management of heart failure patients. The role of biventricular cardiac resynchronisation pacing therapy is less well-established in patients with non-left bundle branch block.

Our study compares procedural outcomes between conduction system pacing and biventricular cardiac resynchronisation pacing in patients with non-left bundle branch block.

An online literature search was systematically conducted to retrieve studies comparing conduction system pacing and biventricular cardiac resynchronisation pacing in patients with non-left bundle branch block. Reported procedural outcomes were implant outcome on paced QRS duration, echocardiographic outcome on improvement in left ventricular ejection fraction, and clinical outcomes on all-cause mortality and heart failure hospitalisation. Risk ratios or mean differences were pooled in comparative random-effects meta-analysis. Forest plots were generated for all outcomes, and funnel plots were inspected for publication bias.

Four studies (279 patients) were included.

Implant derived paced QRS duration was significantly shorter (MD=-19.7, 95%CI=-36.2—3.3, p=0.036) with conduction system pacing. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD=5.6, 95%CI=3.1-8.0, p=0.011) was also observed in conduction system pacing.

There were no statistically significant differences in clinical outcomes, such as all-cause mortality (RR 0.53, 95%CI=0.18-1.60, p=0.133) and heart failure hospitalisation (RR 0.54, 95%CI=0.19-1.56, p=0.129).

This meta-analysis demonstrated better electrical synchrony and echocardiographic response in conduction system pacing compared to biventricular cardiac resynchronisation pacing for patients with non-left bundle branch block. There were no significant differences observed in clinical outcomes, including as all-cause mortality and heart failure hospitalisation.