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

Abstract Background 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. Purpose Our study compares procedural outcomes between conduction system pacing and biventricular cardiac resynchronisation pacing in patients with non-left bundle branch block. Methods 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. Results 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). Conclusion 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.