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Improved all-cause mortality with left bundle branch area pacing compared to biventricular pacing in cardiac resynchronization therapy: a meta-analysis.
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.
Afiliación
  • Diaz JC; Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Clinica Las Vegas, Universidad CES Medical School, Medellin, Colombia.
  • Gabr M; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Tedrow UB; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Duque M; Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Hospital San Vicente Fundacion, Rionegro, Colombia.
  • Aristizabal J; Cardiac Arrhythmia and Electrophysiology Service, Division of Cardiology, Hospital San Vicente Fundacion, Rionegro, Colombia.
  • Marin J; Cardiac Arrhythmia and Electrophysiology Service, Department of Medicine, Division of Cardiology, Clinica Las Americas, Medellin, Colombia.
  • Niño C; Cardiac Arrhythmia and Electrophysiology Service, Clinica SOMER, Rionegro, Colombia.
  • Bastidas O; Cardiac Arrhythmia and Electrophysiology Service, Hospital Pablo Tobon Uribe, Medellin, Colombia.
  • Koplan BA; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Hoyos C; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Matos CD; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Hincapie D; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Pacheco-Barrios K; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
  • Alviz I; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Lima, Peru.
  • Steiger NA; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Kapur S; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Tadros TM; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Zei PC; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Sauer WH; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
  • Romero JE; Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
J Interv Card Electrophysiol ; 2024 Apr 26.
Article en En | MEDLINE | ID: mdl-38668934
ABSTRACT

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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Interv Card Electrophysiol Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Colombia
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Interv Card Electrophysiol Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Colombia