OUTCOMES OF CONDUCTION SYSTEM AND RIGHT VENTRICULAR PACING IN BRADYARRHYTHMIA INDICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROPENSITY-SCORE MATCHED AND RANDOMIZED STUDIES
Tématický okruh: Poruchy rytmu, kardiostimulace | |
| Typ: Ústní sdělení - lékařské , Číslo v programu: 406 | |
| Faizollah Zadeh Ardebili S. 1, Toni George Khairallah T. 2, Dandamudi M. 3, Pinilla J. 4, Hakkeem B. 5, Schettino Samad N. 6, De Paula Portilho N. 7, P. Casillas-Munoz J. 8, Čurila K. 9, Sedláček K. 10 1 Department of Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, 2 Department of Medicine, The University of Georgia, Tbilisi, Georgia, 3 Department of Cardiology, Montefiore Einstein Medical Center, New York City, United States, 4 School of Medicine, CES University, Medellin, Colombia, 5 Department of Medicine, Government Medical College Kozhikode, Kerala, India, 6 School of Medicine, Xavier University, New York City, United States, 7 Department of Cardiology, Federal District Military Firefighter Brigade, Brasília, Brazil, 8 Department of Electrocardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico, 9 Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, 10 First Clinic of Internal Medicine - Cardiology and Angiology, University Hospital and Charles University Medical Faculty, Hradec Kralove | |
Aim: Evidence supporting the use of conduction system pacing (CSP) in bradycardia is currently predominantly based on observational data. To address this gap, 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. Sample and Methodology: We systematically searched three databases for eligible studies. Risk ratios (RR) and mean differences (MD) with their 95% confidence intervals (CI) were pooled using a random effects model. Subgroup analyses of RCTs were performed for key outcomes. Results: Fifteen studies (9 RCTs, 6 PSM) comprising 6,064 patients were included (Figure 1). Compared to RVP, CSP significantly reduced heart failure hospitalizations (RR 0.31; 95% CI 0.21–0.46; p<0.001; Figure 2) 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 a reduction of all-cause mortality in the overall analysis (RR 0.51; 95% CI 0.34–0.78; p=0.002; Figure 3), but not in the RCT-only analysis. 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 durations. Conclusion: CSP 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 still needed to confirm the mortality benefits and long-term safety of CSP. | |
