Effects of Right Ventricular Nonapical Pacing on Cardiac Function: A Meta‐analysis of Randomized Controlled Trials

BackgroundA meta‐analysis of randomized controlled trials (RCTs) was conducted to compare the effects of right ventricular nonapical (RVNA) and right ventricular apical (RVA) pacing on cardiac function.MethodsA systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Library to identify RCTs comparing RVNA pacing with RVA pacing with follow‐up ≥2 months. Twenty RCTs involving 1,114 patients were included.ResultsCompared with RVA pacing, RVNA (mainly right ventricular septum [RVS]) pacing exhibited not only excellent pacing threshold and R‐wave amplitude but also higher impedance. RVNA pacing showed a significant increase in left ventricular ejection fraction (LVEF) at the end of follow‐up (weighted mean difference = 3.58, 95% confidence interval = 1.80–5.35), and the effects were observed in the following subgroups: 6‐month follow‐up, ≤12‐month follow‐up, >12‐month follow‐up, baseline LVEF ≤45%, and baseline LVEF >45%. RVS and RVA pacing significantly differed in improving LVEF (weighted mean difference = 4.82, 95% confidence interval = 2.78–6.87). In addition, RVNA pacing resulted in a narrower QRS duration, a smaller left ventricular end‐systolic volume, and a lower New York Heart Association functional class.ConclusionsThis meta‐analysis found that RVNA (mainly RVS) pacing exhibited satisfactory long‐term lead performance compared with RVA pacing and demonstrated beneficial effects in improving LVEF after the 6‐month follow‐up. Furthermore, it proved superior to RVA pacing in terms of interventricular synchrony and cardiac function.