{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:05:32Z","timestamp":1784775932362,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although right ventricular pacing (RVP) is recommended by most of the guidelines for atrioventricular block, it can cause electrical and mechanical desynchrony, impair left ventricular function, and increase the risk of atrial fibrillation. Recently, the His\u2013Purkinje system pacing, including His bundle pacing (HBP) and left bundle branch pacing (LBBP), has emerged as a physiological pacing modality. However, few studies have compared their efficacy and safety in atrioventricular block (AVB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results:<\/jats:title><jats:p>The PubMed, Web of Science, Cochrane Library, and ScienceDirect databases were searched for observational studies and randomized trials of patients with atrioventricular block requiring permanent pacing, from database inception until 10 January 2022. The primary outcomes were complications and heart failure hospitalization. The secondary outcomes included changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD), pacing parameters, procedure duration, and success rate. After extracting the data at baseline and the longest follow-up duration available, a pairwise meta-analysis and a Bayesian random-effects network meta-analysis were performed. Odds ratios (ORs) with 95% confidence intervals (CIs) or 95% credible intervals (CrIs) were calculated for dichotomous outcomes, whereas mean differences (MDs) with 95% CIs or 95% CrIs were calculated for continuous outcomes. Seven studies and 1,069 patients were included. Overall, 43.4% underwent LBBP, 33.5% HBP, and 23.1% RVP. Compared with RVP, LBBP and HBP were associated with a shorter paced QRS duration and a more preserved LVEF. HBP significantly increased the pacing threshold and reduced the R-wave amplitude. There was no difference in the risk of complications or the implant success rate. The pacing threshold remained stable during follow-up for the three pacing modalities. The pacing impedance was significantly reduced in HBP, while a numerical but non-significant pacing impedance decrease was observed in both LBBP and RVP. LBBP was associated with an increased R-wave amplitude during follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this systematic review and network meta-analysis, HBP and LBBP were superior to RVP in paced QRS duration and preservation of LVEF for patients with atrioventricular block. LBBP was associated with a lower pacing threshold and a greater R-wave amplitude than HBP. However, the stability of the pacing output of LBBP may be a concern. Further investigation of the long-term efficacy in left ventricular function and the risk of heart failure hospitalization is needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic review registration<\/jats:title><jats:p>[<jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?RecordID=315046<\/jats:ext-link>], identifier [CRD42022315046].<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.939850","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T04:33:04Z","timestamp":1666672384000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["A systematic review and Bayesian network meta-analysis comparing left bundle branch pacing, his bundle branch pacing, and right ventricular pacing for atrioventricular block"],"prefix":"10.3389","volume":"9","author":[{"given":"Yue","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongpin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1016\/j.jacc.2018.10.043","article-title":"2018 ACC\/AHA\/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: executive summary: a report of the American college of cardiology\/American heart association task force on clinical practice guidelines.","volume":"74","author":"Kusumoto","year":"2019","journal-title":"J Am Coll Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy.","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1111\/jce.13045","article-title":"Longer paced QRS duration is associated with increased prevalence of right ventricular pacing-induced cardiomyopathy.","volume":"27","author":"Khurshid","year":"2016","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2272","DOI":"10.1016\/j.hrthm.2016.09.027","article-title":"Incidence and predictors of right ventricular pacing-induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function.","volume":"13","author":"Kiehl","year":"2016","journal-title":"Hear Rhythm."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1093\/europace\/euy058","article-title":"Permanent his-bundle pacing: a systematic literature review and meta-analysis.","volume":"20","author":"Zanon","year":"2018","journal-title":"Europace."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2914","article-title":"Demystifying trial networks and network meta-analysis.","volume":"346","author":"Mills","year":"2013","journal-title":"BMJ."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097","article-title":"PRISMA group. 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