Success and complication rates of conduction system pacing: a meta-analytical observational comparison of left bundle
Antonio Parlavecchio1, Giampaolo Vetta2, Giovanni Coluccia3
1Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98124, Messina, Italy. antonioparlavecchio1@gmail.com.
Insights
Left bundle branch area pacing (LBBAP) demonstrated a higher success rate and fewer complications compared to His bundle pacing (HBP). This meta-analysis highlights LBBAP as a potentially superior conduction system pacing strategy.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Conduction system pacing (CSP) strategies like LBBAP and HBP are crucial for cardiac rhythm management.
- Previous comparisons between LBBAP and HBP were limited by small sample sizes and varying outcome definitions.
Purpose of the Study:
- To conduct a meta-analysis comparing the procedural success and complication rates of LBBAP versus HBP.
- To provide a comprehensive overview of the safety and efficacy of these two CSP techniques.
Main Methods:
- Systematic literature search of electronic databases up to March 2023.
- Inclusion of observational studies comparing LBBAP and HBP.
- Analysis of key endpoints: CSP success rate, device-related complications, and lead-related complications.
Main Results:
- LBBAP achieved a significantly higher procedural success rate (91.1%) compared to HBP (80.9%).
- LBBAP demonstrated significantly lower overall complication rates (1.8% vs 5.2%), including lead-related complications (1.1% vs 4.3%) and lead failure/deactivation (0.2% vs 3.9%).
Conclusions:
- This meta-analysis indicates that LBBAP offers a higher success rate than HBP for conduction system pacing.
- LBBAP is associated with a reduced incidence of complications, suggesting it may be a preferable pacing strategy.
Background:
Left bundle branch area pacing (LBBAP) and His bundle pacing (HBP) are the main strategies to achieve conduction system pacing (CSP), but only observational studies with few patients have compared the two pacing strategies, sometimes with unclear results given the different definitions of the feasibility and safety outcomes. Therefore, we conducted a meta-analysis aiming to compare the success and complications of LBBAP versus HBP.
Methods:
We systematically searched the electronic databases for studies published from inception to March 22, 2023, and focusing on LBBAP versus HBP. The study endpoints were CSP success rate, device-related complications, CSP lead-related complications and non-CSP lead-related complications.
Results:
Fifteen observational studies enrolling 2491 patients met the inclusion criteria. LBBAP led to a significant increase in procedural success [91.1% vs 80.9%; RR: 1.15 (95% CI: 1.08-1.22); p < 0.00001] with a significantly lower complication rate [1.8% vs 5.2%; RR: 0.48 (95% CI: 0.29-0.78); p = 0.003], lead-related complications [1.1% vs 4.3%; RR: 0.38 (95% CI: 0.21-0.72); p = 0.003] and lead failure/deactivation [0.2% vs 3.9%; RR: 0.16 (95% CI: 0.07-0.35); p < 0.00001] than HBP. No significant differences were found between CSP lead dislodgement and non-CSP lead-related complications.
Conclusion:
This meta-analysis of observational studies showed a higher success rate of LBBAP compared to HBP with a lower incidence of complications.
