Safety and efficacy of left bundle branch pacing in comparison with conventional right ventricular pacing

Abstract

Background: Right ventricular pacing (RVP) has been widely accepted as a traditional pacing strategy, but long-term RVP has detrimental impact on ventricular synchrony. However, left bundle branch pacing (LBBP) that evolved from His-bundle pacing could maintain ventricular synchrony and overcome its clinical deficiencies such as difficulty of lead implantation, His bundle damage, and high and unstable thresholds. This analysis aimed to appraise the clinical safety and efficacy of LBBP. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing LBBP and RVP. Results: Seven trials with 451 patients (221 patients underwent LBBP and 230 patients underwent RVP) were included in the analysis. Pooled analyses verified that the paced QRS duration (QRSd) and left ventricular mechanical synchronization parameters of the LBBP capture were similar with the native-conduction mode ( P > .7),but LBBP showed shorter QRS duration (weighted mean difference [WMD]: −33.32; 95% confidence interval [CI], −40.44 to −26.19, P < .001), better left ventricular mechanical synchrony (standard mean differences: −1.5; 95% CI: −1.85 to −1.14, P < .001) compared with RVP. No significant differences in Pacing threshold (WMD: 0.01; 95% CI: −0.08 to 0.09, P < .001), R wave amplitude (WMD: 0.04; 95% CI: −1.12 to 1.19, P = .95) were noted between LBBP and RVP. Ventricular impedance of LBBP was higher than that of RVP originally (WMD: 19.34; 95% CI: 3.13–35.56, P = .02), and there was no difference between the 2 groups after follow-up (WMD: 11.78; 95% CI: −24.48 to 48.04, P = .52). And follow-up pacing threshold of LBBP kept stability (WMD: 0.08; 95% CI: −0.09 to 0.25, P = .36). However, no statistical difference existed in ejection fraction between the 2 groups (WMD: 1.41; 95% CI: −1.72 to 4.54, P = .38). Conclusions: The safety and efficacy of LBBP was firstly verified by meta-analysis to date. LBBP markedly preserve ventricular electrical and mechanical synchrony compared with RVP. Meanwhile, LBBP had stable and excellent pacing parameters. However, LBBP could not be significant difference in ejection fraction between RVP during short- term follow-up.

Clinical Outcomes of Left Bundle Branch Area Pacing in Comparison with Right Ventricular Septal Pacing in Patients with High Ventricular Pacing Ratio ≥40%

“…Indeed, recent studies have demonstrated that LBPaP produces better LV mechanical synchrony than RVSP, 14 , 23 , 28 which is consistent with the results of our recently published meta-analysis. 29 In our study, IVMD and SPWMD were lower in the LBBaP group in comparison with the RVSP group, further suggesting that LBBaP could generate better ventricular mechanical synchrony than RVSP. Therefore, as a novel physiological pacing mode, LBBaP can produce good ventricular electrical-mechanical synchronization that is similar to the result of the preoperative native conduction system and better than that of RVSP.…”

Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional Speckle-Tracking Echocardiography

“…Two-dimensional speckle-tracking echocardiography (2D STE) enables quantitative analysis of the degree of deformation in myocardial segments, as well as the scale of contraction dyssynchrony. Previous studies have shown that global longitudinal strain (GLS) and peak systolic dispersion (PSD) enable a more objective, accurate and reproducible assessment of myocardial dysfunction compared with tissue doppler imaging (TDI) or measurement of LVEF [ 8 ], which, so far, have been mainly used to assess the hemodynamic effects of HBP [ 9 , 10 ]. Left atrial volume is a recognised indicator of LV diastolic dysfunction, and it is a good predictor of atrial fibrillation [ 11 ].…”

Echocardiographic Evaluation of the Effect on Left Ventricular Function Between Left Bundle Branch Pacing and Right Ventricular Pacing

“…There are two possible reasons for the result: 1) The sample size was small and the duration of follow-up was short; 2) LBBP is able to improve LVEF of HF patients with BBB, while LBBP and RVP have little effect on LVEF in patients with normal cardiac function and shorter QRSd during short-term follow-up. 24 Therefore, more studies with long-term follow-up are needed to confirm our findings in these patients. After placement of an RV lead through the tricuspid valve apparatus, lead-induced TR may be caused by lead-related tricuspid leaflet injury or perforation or lead entanglement, impingement, or adherence to the tricuspid valve.…”