Work

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

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: 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.

Source: BMC Cardiovascular Disorders

DOI: 10.1186/s12872-025-05336-w