Lead-Related and Procedural Outcomes of His Bundle Pacing Versus Left Bundle Branch Area Pacing in Patients Undergoing Atrioventricular Node Ablation: A Systematic Review and Meta-Analysis

IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2026-07-14 DOI:10.1002/joa3.70419

Norma N. Gamarra-Valverde, Bezalel Hakkeem, Joseph E. Marine, Jhordan Chilon-Cerdan, Adriana C. Mares, Juliana Giorgi

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引用次数: 0

Abstract

Background

In patients undergoing atrioventricular node ablation (AVNA), permanent pacing is required, making lead performance and procedural durability important. His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are physiologic pacing strategies used in this setting, but comparative evidence remains limited.

Methods

We searched PubMed/MEDLINE and Embase through January 31, 2026, for comparative studies of HBP versus LBBAP in adults undergoing AVNA. The primary outcome was chronic lead-related dysfunction, defined as clinically significant chronic capture-threshold elevation. Secondary outcomes were AVNA procedural duration and atrioventricular nodal reconduction requiring repeat ablation. Random-effects models generated pooled risk ratios (RRs) or mean differences (MDs). Certainty was assessed using GRADE.

Results

Three observational studies comprising 434 patients were included. Two studies (n = 270) contributed to chronic lead-related dysfunction, which occurred more often with HBP than LBBAP (RR 15.43, 95% CI 2.80–85.04); the estimate was imprecise because of sparse events. Two studies (n = 262) contributed to procedural duration, which was longer with HBP (MD 11.33 min, 95% CI 6.64–16.02; I² = 0%). Two studies (n = 262) contributed to atrioventricular nodal reconduction, which was more frequent with HBP (RR 19.34, 95% CI 2.60–143.61; I² = 0%). Certainty was low for procedural duration and very low for the other outcomes.

Conclusions

Among patients undergoing AVNA, LBBAP was associated with more favorable lead-related and procedural outcomes than HBP across available observational studies. Because evidence is limited by small cohorts, sparse events, and nonrandomized designs, these findings should be considered hypothesis-generating.

Trial Registration

This systematic review was registered in the PROSPERO database (registration number: CRD420261424072)

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房室结消融患者的束起搏与左束分支起搏的导联相关和手术结果：系统回顾和荟萃分析。

背景：在接受房室结消融（AVNA）的患者中，需要永久性起搏，这使得导联性能和手术耐久性变得重要。他的束起搏（HBP）和左束分支起搏（LBBAP）是在这种情况下使用的生理性起搏策略，但比较证据仍然有限。方法：我们检索PubMed/MEDLINE和Embase到2026年1月31日，以比较成人AVNA中HBP与LBBAP的比较研究。主要结局是慢性铅相关功能障碍，定义为临床显著的慢性捕获阈值升高。次要结果是AVNA手术持续时间和需要重复消融的房室结再传导。随机效应模型生成汇总风险比（rr）或平均差异（MDs）。采用GRADE评估确定性。结果：纳入了3项观察性研究，共434例患者。两项研究（n = 270）导致慢性铅相关功能障碍，HBP比LBBAP更常发生（RR 15.43, 95% CI 2.80-85.04）；由于事件稀少，估计不准确。两项研究（n = 262）对手术时间有影响，HBP患者的手术时间更长（MD 11.33 min, 95% CI 6.64-16.02; CI 2 = 0%）。两项研究（n = 262）发现房室结再传导，高血压患者更常发生房室结再传导（RR 19.34, 95% CI 2.60-143.61; CI 2 = 0%）。手术持续时间的确定性很低，其他结果的确定性也很低。结论：在接受AVNA的患者中，在现有的观察性研究中，LBBAP比HBP更有利于铅相关和程序性结果。由于证据受到小队列、稀疏事件和非随机设计的限制，这些发现应被视为假设生成。试验注册：本系统评价已在PROSPERO数据库中注册（注册号：CRD420261424072）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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