Improved all-cause mortality with left bundle branch area pacing compared to biventricular pacing in cardiac resynchronization therapy: a meta-analysis

• Published in: Journal of interventional cardiac electrophysiology Vol. 67; no. 6; pp. 1463 - 1476
• Main Authors: Diaz, Juan Carlos, Gabr, Mohamed, Tedrow, Usha B., Duque, Mauricio, Aristizabal, Julian, Marin, Jorge, Niño, Cesar, Bastidas, Oriana, Koplan, Bruce A., Hoyos, Carolina, Matos, Carlos D., Hincapie, Daniela, Pacheco-Barrios, Kevin, Alviz, Isabella, Steiger, Nathaniel A., Kapur, Sunil, Tadros, Thomas M., Zei, Paul C., Sauer, William H., Romero, Jorge E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 26.04.2024; Springer Nature B.V
• Subjects: Cardiology; Congestive heart failure; Ejection fraction; Fluoroscopy; Hospitalization; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Reviews; Risk management; Risk reduction; Ventricle; Heart failure; Cardiac resynchronization therapy; Biventricular pacing; Left bundle branch area pacing
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-024-01785-z

Background Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative pacing strategy to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). We aimed to assess the impact of LBBAP vs. BIVP on all-cause mortality and heart failure (HF)-related hospitalization in patients undergoing CRT. Methods Studies comparing LBBAP and BIVP for CRT in patients with HF with reduced left ventricular ejection fraction (LVEF) were included. The coprimary outcomes were all-cause mortality and HF-related hospitalization. Secondary outcomes included procedural and fluoroscopy time, change in QRS duration, and change in LVEF. Results Thirteen studies (12 observational and 1 RCT, n  = 3239; LBBAP = 1338 and BIVP = 1901) with a mean follow-up duration of 25.8 months were included. Compared to BIVP, LBBAP was associated with a significant absolute risk reduction of 3.2% in all-cause mortality (9.3% vs 12.5%, RR 0.7, 95% CI 0.57–0.86, p  < 0.001) and an 8.2% reduction in HF-related hospitalization (11.3% vs 19.5%, RR 0.6, 95% CI 0.5–0.71, p  < 0.00001). LBBAP also resulted in reductions in procedural time (mean weighted difference− 23.2 min, 95% CI − 42.9 to − 3.6, p  = 0.02) and fluoroscopy time (− 8.6 min, 95% CI − 12.5 to − 4.7, p  < 0.001) as well as a significant reduction in QRS duration (mean weighted difference:− 25.3 ms, 95% CI − 30.9 to − 19.8, p  < 0.00001) and a greater improvement in LVEF of 5.1% (95% CI 4.4–5.8, p  < 0.001) compared to BIVP in the studies that reported these outcomes. Conclusion In this meta-analysis, LBBAP was associated with a significant reduction in all-cause mortality as well as HF-related hospitalization when compared to BIVP. Additional data from large RCTs is warranted to corroborate these promising findings. Graphical abstract LBBP, left bundle branch area pacing; BIVP, biventricular pacing; RRR, relative risk reduction; ARR, absolute risk reduction; ms, milliseconds; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; min, minutes