AV Node Ablation and Conduction System Pacing Versus Biventricular Pacing in Patients With AF and HF.
Pacing Clin ElectrophysiolJul 8, 2026 (epub)
Clinical ResearchCardiology
Aya Elalfy, Ahmed Elmorsy Mohamed, Zeyad Kholeif et al.
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In 30 seconds
This systematic review compared conduction system pacing (CSP) and biventricular pacing (BiVP) in patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) undergoing atrioventricular node ablation (AVNA). The analysis included six studies with 766 patients. CSP was associated with a significant reduction in all-cause mortality (RR 0.64 [CI: 0.44 to 0.94], p = 0.02).
Key findings
- CSP significantly reduced all-cause mortality compared to BiVP (RR 0.64 [CI: 0.44 to 0.94], p = 0.02).
- CSP showed a trend towards lower heart failure hospitalization, but it was not statistically significant (RR 0.77 [CI: 0.58 to 1.03], p = 0.08).
- CSP decreased NYHA class by an average of -0.64 (MD [CI: -1.18 to -0.10], p = 0.02).
- CSP significantly reduced QRS duration by -33.56 ms (MD [CI: -52.36 to -14.76], p = 0.0005).
Why it matters
The findings suggest that CSP may provide important clinical benefits over BiVP in patients with AF and HFrEF, particularly in reducing mortality and improving symptoms. This could influence treatment decisions in this high-risk population.