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BackgroundRight Ventricular Pacing (RVP) may have detrimental effects in ventricular function. Left Bundle Branch Area Pacing (LBBAP) is a new pacing strategy that appears to have better results. The aim of this systematic review and meta-analysis is to compare the safety and efficacy of LBBAP vs RVP in patients with bradyarrhythmia and conduction system disorders.MethodsMedline, Embase and Pubmed databases were searched for studies comparing LBBAP with RVP. Outcomes were all-cause mortality, atrial fibrillation (AF) occurrence, heart failure hospitalizations (HFH) and complications. QRS duration, mechanical synchrony and LVEF changes were also assessed. Pairwise meta-analysis was conducted using random and fixed effects models.ResultsTwenty-five trials with 4250 patients (2127 LBBAP) were included in the analysis. LBBAP was associated with lower risk for HFH (RR:0.33, CI 95%:0.21 to 0.50;pp=0.003), and AF occurrence (RR:0.43 CI 95%:0.27 to 0.68;pp=0.780). QRSd was shorter in the LBBAP group at follow-up (WMD: -32.20 msec, CI 95%: -40.70 to -23.71;ppp=0.860) and higher R wave amplitudes (p=0.009) than RVP.ConclusionsLBBAP has better clinical outcomes, preserves ventricular electrical and mechanical synchrony and has excellent pacing parameters, with no difference in complications compared to RVP.Clinical PerspectiveWhat is knownLeft bundle branch area pacing (LBBAP) is a method of conduction system pacing with higher procedural success rate and less limitations compared to His bundle pacing (HBP).Right ventricular pacing (RVP) causes electromechanical dyssynchrony, which may result in left ventricular systolic dysfunction in some patients.What the study addsWe examined in a systematic review and meta-analysis whether there was a difference in clinical outcomes, electromechanical synchronization, and safety between LBBAP and RVP in patients with bradyarrhythmia and conduction system disorders.