Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring
Juan Hua1, Chenxi Wang1, Qiling Kong1
1Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Insights
Left bundle branch area pacing (LBBAP) and His bundle pacing (HBP) improve cardiac function more than biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). LBBAP offers similar benefits to HBP but with lower pacing thresholds.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Comparative efficacy of different cardiac resynchronization therapy (CRT) pacing methods, including biventricular pacing (BVP), His bundle pacing (HBP), and left bundle branch area pacing (LBBAP), is not well-established.
- HBP and LBBAP show potential advantages over traditional BVP for CRT.
Purpose of the Study:
- To systematically compare the effects of BVP, HBP, and LBBAP on CRT outcomes.
- To determine if HBP or LBBAP offer superior results compared to BVP.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library.
- A frequentist random-effects network meta-analysis (NMA) was employed to compare outcomes between the pacing groups.
- Mean differences (MDs) and 95% confidence intervals (CIs) were calculated to assess treatment effects.
Main Results:
- The meta-analysis included 6 studies with 389 patients, with a mean follow-up of 8.03 months.
- LBBAP demonstrated the greatest improvement in left ventricular ejection fraction (LVEF%), followed by HBP, compared to BVP.
- Both HBP and LBBAP significantly narrowed QRS duration compared to BVP, with LBBAP showing a lower pacing threshold than both BVP and HBP.
Conclusions:
- LBBAP and HBP significantly enhance LVEF and reduce QRS duration more effectively than BVP for CRT.
- LBBAP provides comparable clinical outcomes to HBP but with the advantage of lower pacing thresholds, suggesting it may be a preferred option for CRT.
Background:
The comparative effects of different types of cardiac resynchronization therapy (CRT) delivered by biventricular pacing (BVP), His bundle pacing (HBP), and left bundle branch area pacing (LBBAP) remain inconclusive.
Hypothesis:
HBP and LBBAP may be advantageous over BVP for CRT.
Methods:
PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for studies that reported the effects after BVP, HBP, and LBBAP for CRT. The effects between groups were compared by a frequentist random-effects network meta-analysis (NMA), by which the mean differences (MDs) and 95% confidence intervals (CIs) were calculated.
Results:
Six articles involving 389 patients remained for the final meta-analysis. The mean follow-up of these studies was 8.03 ± 3.15 months. LBBAP resulted in a greater improvement in LVEF% (MD = 7.17, 95% CI = 4.31 to 10.04), followed by HBP (MD = 4.06, 95% CI = 1.09 to 7.03) compared with BVP. HBP resulted in a narrower QRS duration (MD = 31.58 ms, 95% CI = 12.75 to 50.40), followed by LBBAP (MD = 27.40 ms, 95% CI = 10.81 to 43.99) compared with BVP. No significant differences of changes in LVEF improvement and QRS narrowing were observed between LBBAP and HBP. The pacing threshold of LBBAP was significantly lower than those of BVP and HBP.
Conclusion:
The NMA first found that LBBAP and HBP resulted in a greater LVEF improvement and a narrower QRS duration compared with BVP. Additionally, LBBAP resulted in similar clinical outcomes but with lower pacing thresholds, and may therefore offer advantages than does HBP for CRT.
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