Left Bundle Branch Area Pacing Versus Right Ventricular Pacing in Patients With Atrioventricular Block: A Systematic...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Left bundle branch area pacing (LBBAP) is an emerging technique for atrioventricular block (AVB) with preserved left ventricular ejection fraction (LVEF).
• LBBAP may offer superior cardiac function compared to traditional right ventricular pacing (RVP).

Purpose of the Study:

• To compare the efficacy and safety of LBBAP versus RVP in patients with AVB and preserved LVEF.
• To evaluate the impact of LBBAP on cardiac function and clinical outcomes.

Main Methods:

• A meta-analysis of 14 studies (10 observational, 4 RCTs) involving 3062 patients with AVB.
• Data extraction on QRS duration, LVEF, LVEDD, heart failure hospitalizations (HFHs), and complications.
• Random-effects models were used to pool effect estimates.

Main Results:

• LBBAP significantly reduced QRS duration, increased LVEF, and decreased LVEDD compared to RVP.
• LBBAP was associated with significantly lower rates of HFHs (OR=0.26).
• No significant differences were found in implant success, impedance, threshold, or complication rates, although RVP showed higher R-wave amplitude increase.

Conclusions:

• LBBAP demonstrates superior performance in cardiac function indicators and reduces HFHs compared to RVP in AVB patients with preserved LVEF.
• The findings suggest LBBAP may be a more effective pacing strategy.
• Further research is warranted due to study heterogeneity and small sample sizes to validate long-term effects.