Conduction system pacing learning curve: Left bundle pacing compared to His bundle pacing

O’Connor, Matthew; Shi, Rui; Kramer, Daniel B.; Riad, Omar; Hunnybun, Daniel; Jarman, Julian W.E.; Foran, John P.; Cantor, E; Markides, Vias; Wong, Tom

doi:10.1016/j.ijcha.2023.101171

Cited by 5 publications

(7 citation statements)

References 7 publications

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“…Our analysis included a significantly larger cohort of patients and newer studies with longer follow-up period. [17][18][19][20] In addition, our study reports data on lead revision that has not been previously reported.…”

Section: Discussionmentioning

confidence: 83%

“…Of the 10 studies, 727 patients undergoing HBP were compared to 869 patients undergoing LBBaP with follow-up durations between 3 and 26 months. [11][12][13][14][15][16][17][18][19][20] The characteristics of the studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Of those, 53 studies were included for full‐text review, and a further 44 studies were excluded leaving 10 studies for the systematic review and meta‐analysis (Figure 1). Of the 10 studies, 727 patients undergoing HBP were compared to 869 patients undergoing LBBaP with follow‐up durations between 3 and 26 months 11–20 . The characteristics of the studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…However, the studies included in this analysis reported small number of patients. Our analysis included a significantly larger cohort of patients and newer studies with longer follow‐up period 17–20 . In addition, our study reports data on lead revision that has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta‐analysis

Abdin,

Werner,

Burri

et al. 2023

Pacing Clinical Electrophis

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BackgroundNovel pacing technologies, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBaP), have emerged to maintain physiological ventricular activation. We investigated the outcomes of LBBP with HBP for patients requiring a de novo permanent pacing.Methods and ResultsSystematic review of randomized clinical trials and observational studies comparing LBBaP with HBP until March 01, 2023 was performed. Random and fixed effects meta‐analyses of the effect of pacing technology on outcomes were performed. Study outcomes included pacing metrics, QRS duration, lead revision, procedure parameters, all‐cause mortality and heart failure hospitalization (HFH). Overall, 10 studies with 1596 patients were included. Implant success rate was higher in LBBaP compared with HBP (RR 1.24, 95% CI: 1.08 to 1.42, p = .002). LBBaP was associated with lower capture threshold at implantation (mean difference (MD) −0.62 V, 95% CI: −0.74 to −0.51 V, p < .0001) and at follow‐up (MD −0.74 V, 95% CI: −0.96 to −0.53, p < .0001), shorter procedure duration (MD −14.66 min, 95% CI: −23.54 to −5.78, p = .001) and shorter fluoroscopy time (MD −4.2 min, 95% CI: −8.4 to −0.0, p = .05). Compared with HBP, LBBaP was associated with a decreased risk of all‐cause mortality (RR: 0.50, 95% CI: 0.33 to 0.77, p = .002) and HFH (RR: 0.57, 95% CI: 0.33 to 1.00, p = .05). No statistical differences were found in lead revisions and QRS duration before and after pacing.ConclusionThis meta‐analysis found that LBBaP was superior to HBP regarding pacing metrics and implant success rate as an initial pacing strategy, although absence of head‐to‐head randomized comparison warrants caution in interpretation of the results.

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Section: Discussionmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta‐analysis

Abdin,

Werner,

Burri

et al. 2023

Pacing Clinical Electrophis

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“…[ 14 – 18 ] LBBAP seems to be comparatively easier from a technical standpoint than HBP, with a shorter learning curve, attributed to a larger target area and implantation deeper in the right ventricle, further away from atrial myocardium. [ 19 ]…”

mentioning

confidence: 99%

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

Diaz,

Duque,

Aristizabal

et al. 2023

Arrhythm Electrophysiol Rev

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Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.

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Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Permanent Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing

Koniari¹,

Gerakaris²,

Kounis³

et al. 2023

Preprint

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Objective: To review the relevant literature on the use of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation. Methods: A PubMed/MEDLINE and SCOPUS search was performed in order to assess the clinical outcomes of atrioventricular node ablation and pacemaker implantation, as well as the complications that may occur. Results: Several clinical trials, observational analyses and meta-analyses have shown that “pace and ablate” strategy not only improves symptoms but also can enhance cardiac performance in patients with heart failure and atrial fibrillation. Although this procedure is effective and safe, some complications may occur including worsening of heart failure, permanent fibrillation, arrhythmias and sudden death. Regarding the implantation of pacemaker, cardiac resynchronization therapy is shown to be the optimal choice compared to right ventricle apical pacing. His bundle pacing is a promising alternative to cardiac resynchronization therapy and has shown beneficial effects, while left bundle brunch pacing is an innovative modality. Conclusions: Atrioventricular node ablation and implantation of pacemaker is shown to have beneficial effects on clinical outcomes of patients with atrial fibrillation ± heart failure who do not respond or are intolerant to medical treatment. Cardiac resynchronization therapy is the treatment of choice and His bundle pacing seems to be an effective alternative way of pacing in these patients.

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Conduction system pacing learning curve: Left bundle pacing compared to His bundle pacing

Cited by 5 publications

References 7 publications

Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta‐analysis

Outcomes of left bundle branch area pacing compared to His bundle pacing as a primary pacing strategy: Systematic review and meta‐analysis

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Permanent Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing

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