{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T21:44:24Z","timestamp":1789422264838,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Right ventricular pacing (RVP), leadless pacing (LL), and conduction system pacing (CSP) are treatment options for atrioventricular block (AVB), each with distinct characteristics. However, the long-term outcomes of these pacing strategies remain insufficiently compared. This study evaluates clinical and echocardiographic outcomes of patients with AVB treated with dual chamber RVP, His bundle pacing (HBP), or LL. Methods: This single-center observational registry study included 22 consecutive patients receiving LL with atrioventricular resynchronization functionality (October 2020 to October 2022), matched with 66 control patients receiving either RVP (33 patients) or HBP (33 patients) using propensity score matching (2:3:3 ratio). Primary and secondary endpoints included all-cause mortality, cardiovascular mortality, heart failure, and echocardiographic outcomes. Atrioventricular synchrony in the LL group was assessed. Results: At two years, all-cause mortality was significantly higher in the LL group compared to RVP (36.4% vs. 6.1%, p = 0.002) and HBP (36.4% vs. 12.1%, p = 0.03), but LL had a more severe clinical profile. Cardiovascular mortality and heart failure incidence showed no significant differences. Patients receiving RVP showed a significant decrease in left ventricular ejection fraction and an increase in ventricular volumes. In contrast, HBP patients exhibited favorable cardiac remodeling. Stratification based on atrial sensing showed that LL patients with &gt;66% AV synchrony had a lower mortality (p = 0.02). Conclusions: CSP offers superior results compared to other pacing methods in terms of ventricular function owing to a physiological ventricular activation and maintenance of AV synchrony. However, LL may be a viable alternative for frail and high-risk patients, as the suboptimal AV synchrony is traded off with lesser ventricular dyssynchrony.<\/jats:p>","DOI":"10.3390\/jcm14030980","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T05:55:22Z","timestamp":1738648522000},"page":"980","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Atrioventricular Block Treatment: Pacing Site, AV Synchrony, or Both?"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4590-8584","authenticated-orcid":false,"given":"Mauro","family":"Biffi","sequence":"first","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Bagatin","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Spadotto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6411-0561","authenticated-orcid":false,"given":"Mirco","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Carecci","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Bartoli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Martignani","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Angeletti","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3823-3809","authenticated-orcid":false,"given":"Igor","family":"Diemberger","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Massaro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1175-3986","authenticated-orcid":false,"given":"Michele","family":"Bertelli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3617-2739","authenticated-orcid":false,"given":"Matteo","family":"Ziacchi","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/europace\/euab232","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"24","author":"Glikson","year":"2022","journal-title":"Europace"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/j.jacc.2018.10.044","article-title":"2018 ACC\/AHA\/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"74","author":"Kusumoto","year":"2019","journal-title":"J. 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