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

Abstract

BackgroundHis 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.MethodsWe 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.ResultsA 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; I2 = 60%, P = 0.0003), lower capture threshold at implantation (V/0.5 ms) (MD: 0.63, 95% CI: 0.35–0.90, I2 = 89%, P < 0.0001) and capture threshold at follow-up (V/0.5 ms) (MD: 0.76, 95% CI: 0.34–1.18, I2 = 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, I2 = 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.ConclusionCurrent evidence suggests that pacing characteristics are better in LBBP compared with HBP. Further prospective studies are needed to validate the clinical advantages of LBBP.

Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

“…BiV pacing is an established treatment option for patients undergoing the “pace and ablate” strategy [ 6 , 7 , 8 ]. Recently reported high acute success rates of HBP and LBBP made these two modalities a potential alternative to BiV [ 24 ]. In the line with these reports, the present study demonstrated successful permanent CSP pacemaker implantation combined with AVNA in all enrolled patients.…”

“…In our study, LBBP appeared to result in shorter fluoroscopy time duration, less complications during AVNA and lower pacing thresholds compared to HBP group and BiV group. Namely, LBBP lead is screwed deep within the LV septum and close to the myocardial tissue, thus stimulating not only the specialized conduction system but also the deep myocardium of the interventricular septum [ 24 ]. In accordance with previous published literature, pacing thresholds in our study remained stable during short-term follow-up in both CSP groups [ 24 , 25 ].…”

“…Namely, LBBP lead is screwed deep within the LV septum and close to the myocardial tissue, thus stimulating not only the specialized conduction system but also the deep myocardium of the interventricular septum [ 24 ]. In accordance with previous published literature, pacing thresholds in our study remained stable during short-term follow-up in both CSP groups [ 24 , 25 ]. Nonetheless, rise in capture threshold was registered in 2 patients with HBP, which required programming to asynchronous RV pacing, therefore favoring LBBP over HBP.…”

Lowering the threshold for left bundle branch area pacing

“…This success rate is similar to that reported in other studies 10 . Other studies have found a higher implant success rate with LBBAP as compared to HBP 11 . Second, this success rate is likely easily reproducible as the implant technique does not require additional or specialized training, only a long delivery sheath and some familiarity with the mechanism to fix the 3830 lead to the interventricular septum.…”

“…10 Other studies have found a higher implant success rate with LBBAP as compared to HBP. 11 Second, this success rate is likely easily reproducible as the implant technique does not require additional or specialized training, only a long delivery sheath and some familiarity with the mechanism to fix the 3830 lead to the interventricular septum. With preliminary data suggesting improved outcomes compared to traditional RV septal pacing 12 and the relative ease of procedural proficiency, it would seem that this technique could rapidly become the gold standard for pacemaker implantation.…”