Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Abstract

Introduction: Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all-cause mortality in HF patients with left bundle branch block (LBBB).Biventricular pacing (BVP) is the gold standard for achieving CRT, but about 30%-40% of patients do not respond to BVP-CRT. Recent studies showed that left bundle branch pacing (LBBP) provided remarkable results in CRT. Therefore, we conducted a meta-analysis aiming to compare LBBP-CRT versus BVP-CRT in HF patients. Methods:We systematically searched the electronic databases for studies published from inception to December 29, 2022 and focusing on LBBP-CRT versus BVP-CRT in HF patients. The primary endpoint was HF hospitalization. The effect size was estimated using a random-effect model as Risk Ratio (RR) and mean difference (MD).Results: Ten studies enrolling 1063 patients met the inclusion criteria. Compared to BVP-CRT, LBBP-CRT led to significant reduction in HF hospitalization [7.9% vs.14.5%;

Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacing

“…Compared to BVP, the LBBP group demonstrated significantly lower capture thresholds at baseline and at 12 months follow-up, which is in line with previous results [ 20 , 26 ]. Lower capture thresholds may increase battery life time.…”

“…As a consequence, greater resynchronization with LBBP translated into a 6 % greater improvement in LVEF as compared to BVP. Recently, in CRT candidates with LBBB Parlavecchio et al [ 20 ] demonstrated that the increase in LVEF with LBBP was 5.8 % higher as compared to conventional BVP, which is comparable to our data. The pronounced decrease in LVESV in LBBP compared with BVP (−53 ml versus −13 ml, respectively) corroborates significant reverse remodelling upon LBBP.…”

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

“…These findings align with a recent meta-analysis that also demonstrated a favorable effect of LBBAP over BiVP in reducing HF hospitalizations. 20 Similarly, our meta-analysis demonstrated improved survival in patients undergoing LBBAP as compared with BiVP. Our results are in contrast with the 2 of the included studies that did not find any mortality benefit with LBBAP use.…”

“…This meta-analysis is an updated analysis that includes 12 studies (3004 patients) and provides more robust evidence than previous meta-analyses that included fewer studies. 18 , 19 , 20 Notably, this is the first meta-analysis to report a mortality benefit with LBBAP over BiVP in patients with systolic HF.…”

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

“…Moreover, the rate of echocardiographic response (defined as an absolute increase in LVEF by ≥5% between baseline and follow-up) and super-response (defined as an absolute increase in LVEF ≥20% or LVEF ≥50%) is significantly higher in patients undergoing LBBAP compared with BiVp (88.5 versus 72.5%; p=0.002; and 60.8 versus 36.5%, p<0.001, respectively). [ 45 ]…”