Lead-Related and Procedural Outcomes of His Bundle Pacing Versus Left Bundle Branch Area Pacing in Patients Undergoing Atrioventricular Node Ablation: A Systematic Review and Meta-Analysis

Background: In patients undergoing atrioventricular node ablation (AVNA), permanent pacing is required, making lead performance and procedural durability important. His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are physiologic pacing strategies used in this setting, but comparative evidence remains limited. Methods: We searched PubMed/MEDLINE and Embase through January 31, 2026, for comparative studies of HBP versus LBBAP in adults undergoing AVNA. The primary outcome was chronic lead-related dysfunction, defined as clinically significant chronic capture-threshold elevation. Secondary outcomes were AVNA procedural duration and atrioventricular nodal reconduction requiring repeat ablation. Random-effects models generated pooled risk ratios (RRs) or mean differences (MDs). Certainty was assessed using GRADE. Results: Three observational studies comprising 434 patients were included. Two studies (n = 270) contributed to chronic lead-related dysfunction, which occurred more often with HBP than LBBAP (RR 15.43, 95% CI 2.80–85.04); the estimate was imprecise because of sparse events. Two studies (n = 262) contributed to procedural duration, which was longer with HBP (MD 11.33 min, 95% CI 6.64–16.02; I² = 0%). Two studies (n = 262) contributed to atrioventricular nodal reconduction, which was more frequent with HBP (RR 19.34, 95% CI 2.60–143.61; I² = 0%). Certainty was low for procedural duration and very low for the other outcomes. Conclusions: Among patients undergoing AVNA, LBBAP was associated with more favorable lead-related and procedural outcomes than HBP across available observational studies. Because evidence is limited by small cohorts, sparse events, and nonrandomized designs, these findings should be considered hypothesis-generating. Trial Registration: This systematic review was registered in the PROSPERO database (registration number: CRD420261424072).