Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Abstract

AbstractIntroductionCardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all‐cause mortality in HF patients with left bundle branch block (LBBB). Biventricular pacing (BVP) is the gold standard for achieving CRT, but about 30%–40% of patients do not respond to BVP‐CRT. Recent studies showed that left bundle branch pacing (LBBP) provided remarkable results in CRT. Therefore, we conducted a meta‐analysis aiming to compare LBBP‐CRT versus BVP‐CRT in HF patients.MethodsWe systematically searched the electronic databases for studies published from inception to December 29, 2022 and focusing on LBBP‐CRT versus BVP‐CRT in HF patients. The primary endpoint was HF hospitalization. The effect size was estimated using a random‐effect model as Risk Ratio (RR) and mean difference (MD).ResultsTen studies enrolling 1063 patients met the inclusion criteria. Compared to BVP‐CRT, LBBP‐CRT led to significant reduction in HF hospitalization [7.9% vs.14.5%; RR: 0.60 (95%CI: 0.39–0.93); p = .02], QRSd [MD: 30.26 ms (95%CI: 26.68–33.84); p < .00001] and pacing threshold [MD: −0.60 (95%CI: −0.71 to −0.48); p < .00001] at follow up. Furthermore, LBBP‐CRT improved LVEF [MD: 5.78% (95%CI: 4.78–6.77); p < .00001], the rate of responder [88.5% vs.72.5%; RR: 1.19 (95%CI: 1.07–1.32); p = .002] and super‐responder [60.8% vs. 36.5%; RR: 1.56 (95%CI: 1.27–1.91); p < .0001] patients and the NYHA class [MD: −0.42 (95%CI: −0.71 to −0.14); p < .00001] compared to BVP‐CRT.ConclusionIn HF patients, LBBP‐CRT was superior to BVP‐CRT in reducing HF hospitalization. Further significant benefits occurred within the LBBP‐CRT group in terms of QRSd, LVEF, pacing thresholds, NYHA class and the rate of responder and super‐responder patients.