Left Bundle Branch Pacing: A Paradigm Shift in Physiological Pacing for Patients With Atrioventricular Block and Preserved Left Ventricular Systolic Function, A Systematic Review and Meta-analysis

His-Purkinje conduction system pacing (HPCSP) via His bundle pacing (HBP) and Left Bundle Branch Pacing (LBBP) offer a physiological approach to pacing by restoring normal ventricular activation. This meta-analysis compares the feasibility, outcomes, and success rates of HBP and LBBP in patients with atrioventricular block (AVB) and preserved left ventricular function. A systematic search identified studies comparing LBBP with HBP in AVB patients with preserved systolic function. Primary outcomes included QRS duration, success rates, pacing threshold, and improvement in R-wave amplitudes. Secondary outcomes were procedure time and fluoroscopy time. Random-effects models calculated odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Methodological quality was assessed using the Newcastle-Ottawa scale. Among 382 screened articles, seven observational studies involving 1035 patients were analyzed. The mean age was 69.9 years, the mean LVEF was 59.3%, and the average follow-up duration was 8.7 months. LBBP showed higher R-wave amplitudes (MD 7.88, 95% CI 7.26 to 8.50, P < 0.0001) and lower pacing thresholds (MD-0.64, 95% CI-0.81 to-0.47, P < 0.0001) com-pared to HBP. LBBP had shorter procedure time (MD-17.81, 95% CI-30.44 to-5.18, P = 0.006) and reduced fluoroscopy time (MD-5.39, 95% CI-8.81 to-1.97, P = 0.002). No significant differences were observed in QRS duration or success rates. LBBP offers advan-tages over HBP, including improved electrical activa-tion, lower pacing thresholds, and shorter procedure and fluoroscopy times. Success rates and QRS dura-tion reductions were comparable between LBBP and HBP. These findings support LBBP as a feasible and effective alternative to HBP in AVB patients with pre-served systolic function. (Curr Probl Cardiol 2023;48:101983.)