Interventional Cardiology Research Updates

Meta-analysis of five randomized trials (N=806) comparing conduction system pacing (CSP) versus right ventricular pacing (RVP) in patients with AV block or high anticipated pacing burden found CSP markedly reduced pacing-induced cardiomyopathy (HR 0.30) and heart-failure hospitalizations (HR 0.24), preserved left ventricular ejection fraction (mean difference +4.41%), and shortened paced QRS duration. All-cause mortality was numerically lower with CSP but did not reach statistical significance.

This trial-level meta-analysis of 13 randomized trials (2,490 patients with atrial fibrillation and heart failure) compared catheter ablation plus guideline-recommended pharmacological therapy (GRPT) versus GRPT alone. Catheter ablation was associated with lower all-cause mortality (HR 0.58), lower cardiovascular death (HR 0.52), fewer HF/AF-related adverse events (HR 0.69), improved LVEF (mean +6%), and better MLWHFQ scores (mean −12 points), with a trend toward improved 6-minute walk distance.

This review summarizes advances in pulmonary arterial hypertension (PAH) over four decades, noting shifts in epidemiology toward older patients with comorbidities and ongoing delays in diagnosis. It highlights pathobiologic insights (including dysregulation of the activin/TGF-β axis), evolving management with upfront oral combination therapy and sotatercept as the first antiremodeling therapy shown in randomized trials to improve hemodynamics, right heart function, and clinical outcomes, while gaps remain in early detection, personalized therapy, and treatments targeting right ventricular failure.