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Background <p>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.</p> Methods <p>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 (<i>n</i> = 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.</p> Results <p>BiV pacing significantly reduced HF hospitalizations (risk ratio [RR] = 0.83, 95% CI 0.69–0.98; <i>p</i> = 0.03) and better preserved LVEF (mean difference = 6.17%, 95% CI 3.85–8.49; <i>p</i> &lt; 0.00001). No significant differences were observed in all-cause mortality (RR = 0.87, 95% CI 0.70–1.08; <i>p</i> = 0.21) or CV death (RR = 0.95, 95% CI 0.75–1.21; <i>p</i> = 0.70). RV pacing showed a borderline improvement in 6MWD (mean difference = 10.3&#xa0;m, 95% CI − 0.1 to 20.7; <i>p</i> = 0.05).</p> Conclusion <p>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.</p> Systematic review registration <p>This systematic review and meta-analysis was retrospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under ID 1080380.</p> Clinical trial number <p>Not applicable.</p>

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Comparative effects of biventricular and right ventricular pacing on clinical outcomes in atrioventricular block: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Ayan Khalid,
  • Anas Rasool,
  • Shaikh Muhammad Daniyal,
  • Muhammad Ibrahim,
  • Fauzaan Ahmed Siddiqui,
  • Muhammad Saad,
  • Muhammad Hasan Siddiqui,
  • Rahul Balach,
  • Hafiz Bilal Ahmed,
  • Isbah Gul,
  • Yamaan Adil,
  • Sabula Tabish,
  • Danish Ali Ashraf,
  • Ahmed Sajid,
  • Romal Jabarkhil

摘要

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.