Outcomes of Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy: An Updated Systematic Review and Meta-analysis

Jian Liang Tan, Justin Z Lee, Vittorio Terrigno, Benjamin Saracco, Shivam Saxena, Jonathan Krathen, Krystal Hunter, Yong-Mei Cha, Andrea M Russo, Jian Liang Tan, Justin Z Lee, Vittorio Terrigno, Benjamin Saracco, Shivam Saxena, Jonathan Krathen, Krystal Hunter, Yong-Mei Cha, Andrea M Russo

Abstract

Background: Real-world data on the use of left bundle branch area pacing (LBBAP) as an alternative novel pacing strategy to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) remains scarce. We aimed to investigate the outcomes of LBBAP as an alternative to BVP as a method of CRT.

Methods: Electronic databases were searched for studies on the use of LBBAP as CRT and studies that compared LBBAP with BVP. The main outcomes examined were changes in New York Heart Association classification, left ventricular end-diastolic diameter, left ventricular ejection fraction, and paced QRS duration post CRT device implantation.

Results: Our meta-analysis included 8 nonrandomized studies with a total of 527 patients who underwent LBBAP as CRT. In studies with a BVP comparison group, patients with LBBAP had a greater reduction in paced QRS (mean difference [MD], 27.91 msec; 95% confidence interval [CI], 22.33-33.50), and a greater improvement in New York Heart Association class (MD, 0.59; 95% CI, 0.28-0.90) and left ventricular ejection fraction (MD, 6.77%; 95% CI, 3.84-9.71). Patients with underlying left bundle branch block appeared to benefit the most from LBBAP compared with patients without underlying left bundle branch block.

Conclusions: LBBAP might be a reasonable option for patients who meet indications for CRT, particularly in those who have limited anatomy or do not benefit from CRT. Randomized trials are needed to compare LBBAP with BVP for CRT and to identify which populations might benefit the most from LBBAP.

© 2021 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of included and excluded studies in the network meta-analyses. Flow chart of identification of published articles retrieved from published data searches and from other sources. Reasons for exclusion of potentially eligible studies are shown.
Figure 2
Figure 2
Forest plot of standardized mean difference in reduction in paced QRS duration, reduction in LVEDD, NYHA improvement, and LVEF improvement (LBBAP vs BVP groups). (A) Reduction in paced QRS duration. (B) Reduction in LVEDD. (C) NYHA improvement. (D) LVEF improvement. BVP, biventricular pacing; CI, confidence interval; LBBAP, left bundle branch area pacing; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; NHYA, New York Heart Association.
Figure 3
Figure 3
Forest plot of standardized mean difference in reduction in QRS duration, NYHA improvement, and LVEF improvement in patients with underlying LBBB. (A) Reduction in paced QRS duration. (B) NYHA improvement. (C) LVEF improvement. CI, confidence interval; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; NHYA, New York Heart Association.
Figure 4
Figure 4
Forest plot of standardized mean difference in reduction in paced QRS duration and LVEF improvement in LBBB vs Non-LBBB groups. (A) Reduction in paced QRS duration. (B) LVEF improvement. CI, confidence interval; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction.

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Source: PubMed

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