Evidence map›Paper›PMID 42406262›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026

Outcomes of conduction system and right ventricular pacing in bradyarrhythmia indications: A systematic review and meta-analysis of propensity-score matched and randomized studies.

Terezia Toni George Khairallah, Saman Faizollah Zadeh Ardebili, Mrunalini Dandamudi, Juan Pinilla, Bezalel Hakkeem, Nathalia Schettino Samad, Natanael de Paula Portilho, Juan P Casillas-Munoz, Karol Čurila, Kamil Sedláček

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Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Terezia Toni George KhairallahFaculty of Medicine, University of Georgia, Tbilisi, Georgia.
Saman Faizollah Zadeh ArdebiliFaculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic.
Mrunalini DandamudiMontefiore Einstein Medical Center, Bronx, NY, USA.
Juan PinillaSchool of Medicine, CES University, Medellin, Colombia.
Bezalel HakkeemGovernment Medical College Kozhikode, Kozhikode, Kerala, India.
Nathalia Schettino SamadXavier University School of Medicine, New York, NY, USA.
Natanael de Paula PortilhoMilitary Fire Brigade of the Federal District, Brasília, DF, Brazil.
Juan P Casillas-MunozDepartment of Electrocardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
Karol ČurilaCardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 50, Prague, 100 34, Czech Republic.
Kamil SedláčekFirst Clinic of Internal Medicine - Cardiology and Angiology, University Hospital and Charles University Medical Faculty, Hradec Kralove, Czech Republic. kamil.sedlacek@fnhk.cz.

Funding

Ministerstvo Zdravotnictví Ceské Republiky MH CZ - DRO, UHHK, 00179906
6 · The paper itself

Abstract

backgroundEvidence supporting the use of conduction system pacing (CSP) in bradycardia is currently predominantly based on observational data. We performed a meta-analysis of recent propensity-score matched (PSM) studies and randomized controlled trials (RCTs) evaluating outcomes of CSP and right ventricular pacing (RVP) in bradycardia indications.

methodsWe systematically searched three databases for eligible studies. Risk ratios (RRs) and mean differences (MDs) with their 95% confidence intervals (CI) were pooled using a random-effects model. Subgroup analyses of RCTs were performed for key outcomes.

resultsFifteen studies (8 RCTs, 7 PSM) comprising 6,064 patients were included. Compared to RVP, CSP significantly reduced heart failure hospitalizations (RR:0.31; 95% CI:0.21-0.46; p < 0.001) and the need for cardiac resynchronization therapy (CRT) upgrades (RR:0.31; 95% CI:0.12-0.78; p = 0.01), while modestly improving left ventricular ejection fraction (MD:3.98%; 95% CI:2.22-5.74; p < 0.001) and resulting in narrower QRS durations (MD:-27.3 ms; 95% CI:-35.9 to -18.6; p < 0.001). These findings were consistent in sub-analyses of RCTs. CSP was associated with reduction of all-cause mortality in the overall analysis (RR:0.51; 95% CI:0.34-0.78; p = 0.002), but not in the RCT and PSM subgroups. No significant differences between groups were observed for cardiovascular mortality (RR:0.49; 95% CI:0.23-1.04; p = 0.06), procedural complications, or atrial fibrillation. CSP was associated with longer procedural and fluoroscopy times.

conclusionCSP significantly reduces the risk of heart failure hospitalizations and the need for CRT upgrades compared to RVP in patients with bradycardia indications. Ongoing, large-scale RCTs are needed to verify the effect of CSP on mortality and its long-term safety.

Indexed as

BradycardiaCardiac pacingConduction system pacingHeart failureMortalityRight ventricular pacing

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.