Meta-Analysis Comparing Safety and Efficacy of Left Bundle Branch Area Pacing Versus His Bundle Pacing
Zhongyu Yuan1, Liting Cheng1, Yongquan Wu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Left bundle branch area pacing (LBBaP) offers advantages over His bundle pacing (HBP) for bradyarrhythmia, including improved lead parameters and shorter procedures. LBBaP is a promising alternative for physiologic ventricular activation via the His-Purkinje system.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) provides physiologic ventricular activation but faces challenges like difficult implantation and suboptimal pacing thresholds.
- Left bundle branch area pacing (LBBaP) has emerged as a potential solution to overcome HBP's limitations.
Purpose of the Study:
- To compare the efficacy and safety of LBBaP versus HBP in patients with bradyarrhythmia.
- To evaluate key pacing parameters, procedural outcomes, and lead-related complications between the two pacing methods.
Main Methods:
- A meta-analysis of 7 nonrandomized controlled studies involving 786 patients (442 LBBaP, 344 HBP).
- Comparison of R wave amplitudes, capture thresholds, procedure/fluoroscopic times, success rates, QRS duration, lead impedance, and complication incidence.
Main Results:
- LBBaP demonstrated significantly higher R wave amplitudes and lower capture thresholds compared to HBP.
- LBBaP was associated with significantly shorter procedure and fluoroscopic times and higher success rates.
- No significant differences were observed in paced QRS durations, lead impedance, or lead-related complications.
Conclusions:
- LBBaP presents a viable alternative to HBP, offering improved lead performance and procedural efficiency.
- LBBaP effectively achieves physiologic ventricular activation by stimulating the native His-Purkinje system.
- Further research may solidify LBBaP's role in cardiac pacing for bradyarrhythmia.
Abstract:
Although His bundle pacing (HBP) can provide a physiologic ventricular activation pattern, it has disadvantages such as the difficulty of lead implantation, reduced R wave amplitudes, and high and unstable pacing thresholds. Recent studies have demonstrated that left bundle branch area pacing (LBBaP) might overcome these deficiencies. A total of 7 nonrandomized controlled studies including 786 patients (n = 442 receiving LBBaP and n = 344 receiving HBP) with bradyarrhythmia were evaluated. Compared with HBP, LBBaP appeared to result in increased R wave amplitudes (at implant: MD 9.84 mV, 95% confidence interval [CI] 7.61 to 12.06 mV; at follow-up: MD 7.62 mV, 95% CI 6.73 to 8.50 mV), lowered capture thresholds (at implant: MD -0.73 V, 95% CI -0.81 to -0.64 V; at follow-up: MD -0.71 V, 95% CI -0.92 to -0.50 V), shortened procedure times (MD -16.70 minutes, 95% CI -26.51 to -6.90 minutes) and fluoroscopic durations (MD -6.16 min, 95% CI -8.28 to -4.03 minutes), and increased success rates (odds ratio 2.14, 95% CI 1.23 to 3.74); all of these differences were significant. However, paced QRS durations, the lead impedance at implantation and follow-up, and incidence of lead-related complications such as lead dislodgement did not significantly differ between LBBaP and HBP. In conclusion, current evidence suggests that LBBaP is a potential alternative to HBP as a pacing modality with which to maintain an ideal physiologic pattern of ventricular activation through native His-Purkinje system stimulation.
