Left bundle branch area pacing vs biventricular pacing for cardiac resynchronization: A systematic review and meta-analysis

Amman Yousaf; Soban Ahmad; Joshua Peltz; Muhammad Junaid Ahsan; Kirellos Said Abbas; Shoaib Muhammad; Christopher Watson; Zain Ul Abideen Asad; Michael H Kim

doi:10.1016/j.hroo.2023.06.011

Left bundle branch area pacing vs biventricular pacing for cardiac resynchronization: A systematic review and meta-analysis

Heart Rhythm O2. 2023 Nov 11;4(11):671-680. doi: 10.1016/j.hroo.2023.06.011. eCollection 2023 Nov.

Authors

Amman Yousaf¹, Soban Ahmad², Joshua Peltz², Muhammad Junaid Ahsan³, Kirellos Said Abbas⁴, Shoaib Muhammad⁵, Christopher Watson², Zain Ul Abideen Asad⁶, Michael H Kim⁷

Affiliations

¹ Department of Medicine, McLaren Flint-Michigan State University, Flint, Michigan.
² Department of Medicine, East Carolina University, Greenville, North Carolina.
³ Division of Cardiology, Iowa Heart Center, Des Moines, Iowa.
⁴ Department of Medicine, Alexandria University, Alexandria, Egypt.
⁵ Department of Medicine, Gulab Devi Hospital, Lahore, Pakistan.
⁶ Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
⁷ Department of Medicine, Creighton University and CHI Health, Omaha, Nebraska.

Abstract

Background: Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF).

Objective: The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP.

Methods: We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively.

Results: We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, P < .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, P < .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, P < .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, P < .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, P = .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, P < .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, P = .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, P < .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, P < .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, P < .0001) as compared with BiVP.

Conclusion: Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.

Keywords: BiVP; Biventricular pacing; CRT; Cardiac resynchronization therapy; Heart failure; Hospitalization; LBBAP; Left bundle branch block area pacing.