Left bundle branch area pacing in heart failure: A systematic review and meta‐analysis with meta‐regression

Author:

El Iskandarani Mahmoud1,Golamari Reshma2,Shatla Islam3,Ujueta Francisco2ORCID,Mihos Christos G.2,Escolar Esteban2,Elajami Tarec K.2,Weiss Raul2ORCID

Affiliation:

1. Department Internal Medicine Eastern Connecticut Health Network Manchester Connecticut USA

2. Columbia University Division of Cardiology Mount Sinai Medical Center Miami Beach Florida USA

3. Department of Internal Medicine Kansas University Medical Center Kansas City Kansas USA

Abstract

AbstractIntroductionLeft bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).ObjectivesThe study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).BackgroundCardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT.MethodA search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta‐analysis version 4 was used for meta‐regression to examine variables that contribute to data heterogeneity.ResultEighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: −47.23  ms 95% confidence interval [CI]: −53.45, −41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: −1.23, 95% CI: −1.41, −1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: −20.69 ms, 95% CI: −25.49, −15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all‐cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP.ConclusionLBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes.

Publisher

Wiley

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