Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta-analysis.
Pacing Clin Electrophysiol
; 46(5): 432-439, 2023 05.
Article
em En
| MEDLINE
| ID: mdl-37036831
ABSTRACT
INTRODUCTION:
Cardiac 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.METHODS:
We 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).RESULTS:
Ten 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.CONCLUSION:
In 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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Septo Interventricular
/
Terapia de Ressincronização Cardíaca
/
Insuficiência Cardíaca
Tipo de estudo:
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article