Objective:

To determine the pooled permanent pacemaker rate after Commando and Hemi-Commando procedures.

Approach:

Key Findings:

• Twelve studies with 13 data points (797 patients) were included. The pooled permanent pacemaker rate was 22.3% (95% CI: 16.1%–30.0%), with substantial heterogeneity (I² = 73.7%).
• The Chimney Commando modification had a significantly lower rate of 6.3% (95% CI: 3.2%–12.1%) compared to the traditional Commando procedure at 28.3% (95% CI: 21.2%–36.7%; p < 0.001).
• Sensitivity analyses confirmed the robustness of findings, while Egger's test indicated potential small-study effects (p = 0.0041).

Interpretation:

Limitations:

• The evidence is limited and should be considered hypothesis-generating.
• Future prospective comparative studies are needed to validate findings.

Conclusion:

Sources:

• Systematic Review Registration
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