Efficacy and safety of left bundle branch pacing compared with left ventricular septal pacing: A systematic review
Iwan Cahyo Santosa Putra1, Raymond Pranata1, Mohammad Iqbal1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
Insights
Left bundle branch pacing (LBBP) is more effective than left ventricular septal pacing (LVSP) for patients with reduced ejection fraction and wide QRS. For other patients, LBBP and LVSP show similar efficacy and safety.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are pacing techniques with debated comparative efficacy and safety.
- Existing research comparing LBBP and LVSP yields inconclusive results regarding optimal patient selection and outcomes.
Purpose of the Study:
- To systematically compare the efficacy and safety of LBBP versus LVSP through a meta-analysis.
- To evaluate differences in procedural parameters, electrophysiological measures, echocardiographic outcomes, and clinical endpoints between LBBP and LVSP.
Main Methods:
- A comprehensive literature search was performed across major databases (PubMed, Europe PMC, ScienceDirect).
- Included 22 cohort studies with 1360 LBBP and 1186 LVSP procedures.
- Analyzed procedural duration, complications, electrophysiological and echocardiographic parameters, and clinical outcomes.
Main Results:
- LBBP showed significantly shorter paced QRS duration and stimulus-to-LV activation time.
- In patients with reduced LVEF and wide QRS, LBBP led to a greater LVEF improvement and reduced mortality/heart failure hospitalization risk.
- No significant differences were observed in procedural duration, complications, or pacing parameters between LBBP and LVSP.
Conclusions:
- LBBP is superior to LVSP in patients with reduced LVEF and wide QRS duration.
- Efficacy of LBBP and LVSP is comparable in patients with preserved LVEF and narrow QRS duration.
- Both pacing methods offer similar safety profiles and procedural efficiency.
Background:
Although numerous studies have compared the efficacy and safety of left bundle branch pacing (LBBP) and left ventricular (LV) septal pacing (LVSP), the results remain inconclusive.
Objective:
This meta-analysis aimed to systematically compare the efficacy and safety of LBBP with that of LVSP.
Methods:
A comprehensive literature search was conducted across PubMed, Europe PMC, and ScienceDirect to identify studies comparing procedural duration, complications, electrophysiological and echocardiographic parameters, and clinical outcomes between LBBP and LVSP.
Results:
A total of 22 cohort studies, involving 1360 LBBP and 1186 LVSP procedures, were included. The paced QRS duration (mean difference [MD] = -9.65 ms; 95% confidence interval [CI], -13.35 to -5.96; I2 = 84.9%; P < .001) and stimulus-to-LV activation time (MD = -14.62 ms; 95% CI, -16.99 to -12.24; I2 = 77.2%; P < .001) were significantly shorter in the LBBP group. In patients with reduced LV ejection fraction (LVEF) and wide QRS duration, the improvement in LVEF was significantly greater in the LBBP group (MD = 6.05%; 95% CI, 2.9-9.2; I2 = 51.3%; P < .001). In addition, the LBBP group demonstrated a significant reduction in the risk of all-cause mortality and/or heart failure hospitalization (risk ratio = 0.28; 95% CI, 0.17-0.48; I2 = 0%; P < .001). In patients with preserved LVEF and narrow QRS duration, postpacemaker implantation LVEF and LV end-diastolic diameter and the risk of heart failure hospitalization were comparable between the 2 groups. Furthermore, procedural duration, complications, and pacing parameters (sensing amplitude, capture threshold, and lead impedance) did not significantly differ between the groups.
Conclusion:
In patients with reduced LVEF and wide QRS duration, LBBP demonstrates superior efficacy compared with LVSP. In contrast, in patients with preserved LVEF and narrow QRS duration, the efficacy of LBBP and LVSP is similar. Both groups exhibit comparable safety profiles and procedural efficiency.
