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His-Purkinje conduction system pacing: A systematic review and network meta-analysis in bradycardia and conduction

Qiang Qu1,2, Jin-Yu Sun1,2, Zhen-Ye Zhang1

  • 1Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.

Journal of Cardiovascular Electrophysiology
|October 19, 2021
PubMed

Insights

Left bundle branch pacing (LBBP) shows improved outcomes over His bundle pacing (HBP) for bradycardia treatment. Both His-Purkinje conduction system pacing (HPCSP) methods are superior to right ventricular pacing (RVP), offering physiological activation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Right ventricular pacing (RVP) has limitations due to suboptimal ventricular activation.
  • His-Purkinje conduction system pacing (HPCSP) offers physiological activation but comparative data for His bundle pacing (HBP) and left bundle branch pacing (LBBP) is limited.

Purpose of the Study:

  • To compare the efficacy and safety of HBP, LBBP, and RVP using a network meta-analysis.
  • To evaluate pacing parameters, electrophysiological characteristics, and clinical outcomes across different pacing strategies.

Main Methods:

  • A Bayesian random-effects network analysis was performed.
  • Systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science up to September 21, 2021.
  • Inclusion of 28 studies with 4160 patients.

Main Results:

  • LBBP demonstrated superior success rates, pacing thresholds, impedance, and R-wave amplitude compared to HBP.
  • HBP showed significantly shorter paced QRS duration than LBBP.
  • HPCSP (HBP and LBBP) was associated with better left ventricular function and fewer heart failure hospitalizations than RVP, despite RVP having shorter procedure times.

Conclusions:

  • HPCSP, including LBBP and HBP, is effective for bradycardia and conduction disorders.
  • Significant differences exist between LBBP and HBP in pacing parameters and outcomes.
  • Larger, long-term studies are needed to further validate these findings.
Abstract

Keywords:
His bundle pacingHis-Purkinje conduction system pacingbradycardia and conduction disordersleft bundle branch pacingright ventricular pacing

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