Abstract 4343294: Left Bundle Branch Area Pacing Improves Mortality and Heart Failure Outcomes Compared to Right Ventricular Pacing in Atrioventricular Block: A Systematic Review and Meta-Analysis

Background: Left bundle branch area pacing (LBBAP) is an emerging physiologic pacing strategy that may offer advantages over conventional right ventricular pacing (RVP) in patients with atrioventricular (AV) block. This systematic review and meta-analysis evaluates the comparative safety and efficacy of LBBAP versus RVP. Methods: PubMed, Cochrane Library, and Google Scholar were systematically searched to identify studies comparing LBBAP and RVP in patients with AV block. Data were pooled using a random-effects model. Outcomes included paced QRS duration, all-cause mortality, heart failure hospitalization, left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVDD), and periprocedural complications. Results: The meta-analysis examined nine studies (6 observational and three randomized controlled trials). The analysis of pacing parameters demonstrated significantly reduced paced QRS duration with LBBAP compared to RVP (MD [95% CI]: -35.91 [-40.68, -31.15], p-value < 0.00001), and primary outcomes revealed a significant reduction in all-cause mortality (RR [95% CI]: 0.49 [0.34, 0.72], p-value: 0.0002), and heart failure hospitalization associated with LBBAP (RR [95% CI]: 0.35 [0.23, 0.53], p-value: < 0.00001). Secondary outcomes, including periprocedural complications and changes in LVEF and LVDD exhibited non-significant increases in complications (RR [95% CI]: 1.14 [0.66, 1.95], p-value: < 0.64) and significant improvements in LVEF (MD [95% CI]: 3.35 [0.29, 6.35], p-value: 0.03). At the same time, LVDD showed a non-significant decrease (MD [95% CI]: -2.28 [-4.94, 0.37], p-value: 0.09). Conclusion: LBBAP demonstrates superior clinical outcomes compared to RVP in patients with AV block, including reduced mortality, heart failure hospitalization, and improved LVEF and paced QRS duration. Larger randomized trials are warranted to confirm these findings and guide clinical practice.