Beyond biventricular pacing: Exploring the advantages of his-bundle pacing and left bundle branch pacing in heart
Hussam Al Hennawi1, Muhammad Khuzzaim Khan2, Momina Khalid3
1Department of Internal Medicine, Jefferson Abington Hospital, Abington, Philadelphia, USA.
Insights
His-Purkinje system pacing (HPSP) improved cardiac function and heart failure symptoms more than biventricular pacing (BiVP). LBBP, a type of HPSP, showed superior outcomes in electrical synchrony and systolic function.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Heart failure (HF) with left ventricular (LV) dysfunction and dyssynchrony necessitates advanced pacing therapies.
- Conventional biventricular pacing (BiVP) is a standard treatment, but novel techniques are emerging.
Approach:
- A meta-analysis of 18 studies (5 RCTs, 13 observational) involving 1291 patients was conducted.
- Data up to May 2023 were analyzed, comparing His-Purkinje system pacing (HPSP) with BiVP.
- Key outcomes included QRS duration, LV ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), HF hospitalization, and NYHA functional class.
Key Points:
- His-Purkinje system pacing (HPSP) resulted in the shortest QRS duration compared to other pacing methods.
- Left bundle branch area pacing (LBBP), a modality of HPSP, demonstrated the greatest improvement in LVEF, LVEDD, and NYHA functional class.
- No significant difference in HF hospitalization rates was observed between HPSP and BiVP.
Conclusions:
- LBBP, as a His-Purkinje system pacing (HPSP) technique, offers superior outcomes in electrical ventricular synchrony and systolic function.
- HPSP, particularly LBBP, shows promise in alleviating heart failure symptoms compared to conventional pacing.
- Further research may solidify HPSP's role in advanced cardiac resynchronization therapy.
Background:
This meta-analysis compares His-Purkinje system pacing (HPSP), a novel cardiac resynchronization therapy (CRT) technique that targets the intrinsic conduction system of the heart, with conventional biventricular pacing (BiVP) in heart failure (HF) patients with left ventricular (LV) dysfunction and dyssynchrony.
Methods:
We searched multiple databases up to May 2023 and identified 18 studies (five randomized controlled trials and 13 observational studies) involving 1291 patients. The outcome measures were QRS duration, left ventricular ejection fraction (LVEF) improvement, left ventricular end-diastolic diameter (LVEDD) change, HF hospitalization, and New York Heart Association (NYHA) functional class improvement. We used a random-effects model to calculate odds ratios (OR), and mean differences (MD) with 95% confidence intervals (CI). We also assessed the methodological quality of the studies.
Results:
The mean LVEF was 30.7% and the mean follow-up duration was 8.1 months. Among LBBP, HBP, and BiVP, HBP provided the shortest QRS duration [MD: -18.84 ms, 95% CI: -28.74 to -8.94; p = 0.0002], while LBBP showed the greatest improvement in LVEF [MD: 5.74, 95% CI: 2.74 to 7.46; p < 0.0001], LVEDD [MD: -5.55 mm, 95% CI: -7.51 to -3.59; p < 0.00001], and NYHA functional class [MD: -0.58, 95% CI: -0.80 to --0.35; p < 0.00001]. However, there was no significant difference in HF hospitalization between HPSP and BiVP.
Conclusion:
LBBP as modality of HPSP demonstrated superior outcomes in achieving electrical ventricular synchrony and systolic function, as well as alleviating HF symptoms, compared to other pacing techniques.
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