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 primer on cardiac sarcoidosis organizes diagnosis around two contexts—de novo cardiac presentations with unexplained atrioventricular block, ventricular arrhythmia, or heart failure, and cardiac screening in patients with extracardiac sarcoidosis—and emphasizes that no single test achieves both high sensitivity and specificity and that major consensus documents can yield discordant diagnoses. In nonurgent cases, concordant cardiac MRI and FDG-PET abnormalities are accepted as sufficient for diagnosis, endomyocardial biopsy is recommended when imaging is inconclusive or giant cell myocarditis must be excluded, advanced imaging should precede device implantation, and a 5-step pathway integrating imaging, tissue acquisition when it would change management, and genetic evaluation is proposed, though no diagnostic approach has been prospectively validated.