Pacing Characteristics of His Bundle Pacing vs. Left Bundle Branch Pacing: A Systematic Review and Meta-Analysis

Wen Zhuo; Xiaojie Zhong; Hualong Liu; Jianhua Yu; Qi Chen; Jinzhu Hu; Qinmei Xiong; Kui Hong

doi:10.3389/fcvm.2022.849143

Pacing Characteristics of His Bundle Pacing vs. Left Bundle Branch Pacing: A Systematic Review and Meta-Analysis

Front Cardiovasc Med. 2022 Mar 22:9:849143. doi: 10.3389/fcvm.2022.849143. eCollection 2022.

Authors

Wen Zhuo¹, Xiaojie Zhong¹, Hualong Liu¹, Jianhua Yu¹, Qi Chen¹, Jinzhu Hu¹, Qinmei Xiong¹, Kui Hong^{1

2

3}

Affiliations

¹ Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
² Jiangxi Key Laboratory of Molecular Medicine, Nanchang University, Nanchang, China.
³ Department of Genetic Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.

Abstract

Background: His bundle pacing (HBP) is a physiological pacing strategy, which aims to capture the His bundle-Purkinje system and synchronously activate the ventricles. Left bundle branch pacing (LBBP) is a newly discovered physiological pacing technique similar to HBP. We conducted this meta-analysis to compare the pacing parameters and clinical results between HBP and LBBP.

Methods: We systematically retrieved studies using the PubMed, Embase database, and Cochrane Library. Mean difference (MD) and relative risk (RR) with their 95% confidence intervals [CIs] were used to measure the outcomes. A random-effect model was used when studies were of high heterogeneity.

Results: A total of seven studies containing 867 individuals were included. Compared with HBP, LBBP was associated with higher implant success rates (RR: 1.12, 95% CI: 1.05-1.18; I ² = 60%, P = 0.0003), lower capture threshold at implantation (V/0.5 ms) (MD: 0.63, 95% CI: 0.35-0.90, I ² = 89%, P < 0.0001) and capture threshold at follow-up (V/0.5 ms) (MD: 0.76, 95% CI: 0.34-1.18, I ² = 93%, P = 0.0004), and larger sensed R wave amplitude (mV) at implantation (MD: 7.23, 95% CI: 5.29-9.16, P < 0.0001) and sensed R wave amplitude (mV) at follow-up (MD: 7.53, 95% CI: 6.85-8.22, P < 0.0001). In LBBP recipients, greater QRS wave complex reduction was found in the paced QRS duration at follow-up compared with HBP recipients at follow-up (MD: 6.12, 95% CI: 1.23-11.01, I ² = 0%, P = 0.01). No statistical differences were found in procedure duration, fluoroscopy time, native left ventricular ejection fractions (LVEF), LVEF improvement, native QRS duration, and QRS reduction from the native QRS duration vs. paced QRS duration at implantation.

Conclusion: Current evidence suggests that pacing characteristics are better in LBBP compared with HBP. Further prospective studies are needed to validate the clinical advantages of LBBP.

Keywords: his bundle pacing; left bundle branch pacing; pacing parameters; physiologic pacing; prognosis.

Publication types

Systematic Review