Left Bundle Branch Area Pacing Versus Biventricular Pacing in Cardiac Resynchronization Therapy: A Systematic Review...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Left bundle branch area pacing (LBBAP) is an alternative to biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT).
• The physiological targeting of LBBAP offers potential advantages over BiVP.

Purpose of the Study:

• To systematically review and compare the clinical and procedural outcomes of LBBAP versus BiVP in CRT patients.
• To evaluate the impact of LBBAP on mortality, hospitalizations, and cardiac function.

Main Methods:

• A systematic search of major databases (PubMed, Cochrane Central, Embase) was performed.
• Included studies were randomized and observational, comparing LBBAP and BiVP in CRT.
• Meta-analyses used inverse-variance random-effects models to assess outcomes like mortality, LVEF, and QRS duration.

Main Results:

• LBBAP demonstrated significantly lower all-cause mortality (9.9% vs. 13.9%) and HF-related hospitalizations compared to BiVP.
• LBBAP led to greater improvements in LVEF (4.71%) and QRS duration narrowing (-24.60 ms).
• Procedural and fluoroscopy times were significantly shorter with LBBAP.

Conclusions:

• LBBAP is associated with superior clinical outcomes, including reduced mortality and hospitalizations, compared to BiVP for CRT.
• LBBAP offers procedural benefits and enhances cardiac electrical and functional parameters.
• Further large-scale randomized trials are recommended to validate these findings.