Clinical, procedural and lead outcomes associated with different pacing techniques: a network meta-analysis

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• His-Purkinje system pacing (HPSP) is emerging as an alternative to traditional biventricular pacing (BVP) and right ventricular pacing (RVP).
• Understanding the comparative outcomes of different pacing techniques is crucial for optimizing cardiac device therapy.

Purpose of the Study:

• To conduct a meta-analysis comparing clinical, procedural, and lead-related outcomes of various cardiac pacing techniques.
• Evaluate the efficacy and safety of His-bundle pacing (HBP), left bundle branch pacing (LBBP), BVP, and RVP.

Main Methods:

• A comprehensive literature search was performed across scientific databases up to May 2022.
• Thirty-three studies involving 4386 patients were included in the meta-analysis.
• Patients received RVP (1324), BVP (1032), HBP (1069), or LBBP (968).

Main Results:

• LBBP significantly increased left ventricular ejection fraction (LVEF) compared to HBP and BVP.
• Both LBBP and HBP demonstrated significant QRS duration narrowing compared to BVP, with LBBP showing the greatest effect.
• LBBP was associated with a significant reduction in heart failure hospitalizations (HFH) compared to BVP and HBP.
• Compared to RVP, BVP and HBP showed a higher risk of lead issues, while LBBP did not.

Conclusions:

• LBBP offers significant advantages over other pacing techniques, including improved LVEF and QRS narrowing.
• LBBP is associated with reduced heart failure hospitalizations and a favorable lead issue profile.
• HBP showed increased pacing thresholds and reduced R-wave amplitude over time compared to LBBP.