Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis

Abstract

Background: Left bundle branch area pacing (LBBAP) is a recently proposed method for conduction system pacing. We performed a meta-analysis of controlled studies to compare the clinical outcome in patients who received LBBAP vs. biventricular pacing (BVP) for cardiac resynchronization therapy (CRT).Methods: PubMed, Embase, and Cochrane's Library databases were searched for relevant controlled studies. A random-effect model incorporating the potential heterogeneity was used to synthesize the results.Results: Four non-randomized controlled studies including 249 patients with heart failure (HF) for CRT were included, and the patients were followed for 6–12 months. Compared with BVP, LBBAP was associated with significantly shortened QRS duration [mean difference (MD): −29.18 ms, 95% confidence interval (CI): −33.55–24.80, I2 = 0%, P < 0.001], improved left ventricular ejection fraction (MD: 6.93%, 95% CI: 4.69–9.17, I2 = 0%, P < 0.001), reduced left ventricular end-diastolic dimension (MD: −2.96 mm, 95% CI: −5.48 to −0.44, I2 = 0%, P = 0.02), and improved New York Heart Association class (MD: −0.54, 95% CI: −0.84 to −0.24, I2 = 65%, P < 0.001). Moreover, patients who received LBBAP were more likely to achieve echocardiographic [odds ratio (OR): 5.04, 95% CI: 2.17–11.69, I2 = 0%, P < 0.001] and clinical (OR: 7.33, 95% CI: 1.62–33.16, I2 = 0%, P = 0.01) CRT responses.Conclusion: Current evidence from non-randomized studies suggests that LBBAP appears to be a promising method for CRT, which is associated with more remarkable improvements of symptoms and cardiac function in HF patients with indication for CRT.

Can Left Bundle Branch Area Pacing Be a Panacea for Cardiac Resynchronization?: A Case That Puts This Theory in Question

“…LBBaP is a physiological pacing method, and the efficacy of LBBaP is not inferior to that of BIV-CRT for heart failure with cardiac electromechanical activity asynchrony [2][3][4][5] . However, studies have shown that LBBaP cannot achieve cardiac resynchronization in patients with the following situations: (1) complete LBBB block sites distal to the LBB [8] , (2) nonspecific IVCD [6] , (3) myocardial fibrosis because of myocardial infarction or myocardiopathy [9] , (4) right atrium or right ventricle enlargement [9] , and (5) a tendency for interventricular septal perforation because of a thin or soft interventricular septum [10] .…”

“…The guideline recommends biventricular-CRT (BIV-CRT) as the primary method for the treatment of cardiac electromechanical dyssynchrony [1] . In recent years, increasing evidence has shown that the efficacy of left bundle branch area pacing (LBBaP) is not inferior to that of BIV-CRT for heart failure cardiac electromechanical activity asynchrony [2][3][4][5] . However, LBBaP is not suitable for all heart failure patients with cardiac desynchronization, and our center has treated such a patient.…”

Alternative pacing strategies for optimal cardiac resynchronization therapy

“…Finally, HBP and LBBP delivered similar improvement in the LVEF and NYHA class after the 1-year follow-up, which was significantly higher than that in BVP. Furthermore, some meta-analyses of LBBAP for CRT have been reported ( 62 , 63 ). A meta-analysis compared LBBAP and BVP for CRT ( 62 ).…”

“…Furthermore, some meta-analyses of LBBAP for CRT have been reported ( 62 , 63 ). A meta-analysis compared LBBAP and BVP for CRT ( 62 ). Compared with BVP, LBBAP produced significantly narrower QRSd with a mean difference (MD) 29.18 ms, LVEF improvement of 6.93%, LVEDD reduction of 2.96 mm, and NYHA class improvement of 0.54.…”

Success rates, challenges and troubleshooting of left bundle branch area pacing as a cardiac resynchronization therapy for treating patients with heart failure

“…It is encouraging that a novel physiological pacing strategy, LBBaP that has emerged in recent years has significant advantages ( 18 ) ( Figures 1C , F ). Meanwhile, mounting evidence indicates that LBBaP appears to be an effective method for CRT, and is associated with improvements of symptoms and cardiac function ( 19 – 22 ). The result of latest, prospective, randomized study of LBBaP-CRT vs. BiV-CRT has shown that LBBaP-CRT could achieve better LVEF improvement than BiV-CRT in heart failure patients with non-ischemic cardiomyopathy and left bundle branch block (LBBB) ( 23 ).…”