Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2024; 16(1): 40-48
Published online Jan 26, 2024. doi: 10.4330/wjc.v16.i1.40
Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block: A systematic review and meta-analysis
Farah Yasmin, Abdul Moeed, Rohan Kumar Ochani, Hamna Raheel, Malik Ali Ehtsham Awan, Ayesha Liaquat, Arisha Saleem, Muhammad Aamir, Nael Hawwa, Salim Surani
Farah Yasmin, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511, United States
Abdul Moeed, Hamna Raheel, Malik Ali Ehtsham Awan, Ayesha Liaquat, Arisha Saleem, Department of Medicine, Dow University of Health Science, Karachi 74200, Sindh, Pakistan
Rohan Kumar Ochani, Department of Medicine, SUNNY Upstate Medical University, Syracuse, NY 13210, United States
Muhammad Aamir, Nael Hawwa, Department of Cardiovascular Medicine, Lehigh Valley Heart and Vascular Institute, Allentown, PA 18105, United States
Nael Hawwa, Department of Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Salim Surani, Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
Author contributions: Yasmin F, Moeed A, Ochani RK participated in the conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing of the original draft; Raheel H, Awan MAE, Liaquat A, Saleem A were involved in project administration, and writing of the original draft; Yasmin F, Moeed A, Aamir M, Hawwa N, and Surani S were involved in the formal analysis, project administration, supervision, validation, visualization, and writing - review & editing.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FCCP, MD, MHSc, Academic Editor, Professor, Department of Medicine & Pharmacology, Texas A&M University, No. 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: August 29, 2023
Peer-review started: August 29, 2023
First decision: October 24, 2023
Revised: November 21, 2023
Accepted: January 2, 2024
Article in press: January 2, 2024
Published online: January 26, 2024
ARTICLE HIGHLIGHTS
Research background

Biventricular pacing (BiVP) is the conventional mode of cardiac resynchronization therapy (CRT) for left bundle branch block (LBBB) with heart failure (HF), and shows significantly improved patient mortality. However, approximately one-third of the patients fail to response to it. Left bundle branch pacing (LBBP) has gained increasing attention recently as an effective mode of CRT showing complete reversal of LBBB among HF patients.

Research motivation

Several clinical studies evaluating the efficacy of LBBP-CRT in improving electromechanical resynchronization, clinical, and echocardiographic response in comparison to BiVP-CRT among patients with reduced left ventricular ejection fraction (LVEF), LBBP, and HF have been published but the results remain inconclusive. Hence, we performed an updated analysis pooling the recent clinical data to provide a comprehensive clinical evaluation of the efficacy of LBBP-CRT and confirm the validity of the improved electromechanical resynchronization and clinical outcomes in comparison to BiVP-CRT.

Research objectives

The primary outcome of interest was QRS duration. Secondary outcomes included pacing threshold, New York Heart Association (NYHA) classification, B-type natriuretic peptide (BNP) level, and echocardiographic parameters, including LVEF, l left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD).

Research methods

An extensive literature search was conducted using MEDLINE (PubMed), Cochrane Library, and Scopus from inception through October 2022 to identify relevant studies evaluating the clinical and echocardiographic metrics between LBBP-CRT vs BiVP-CRT among HF patients with LBBB. A random-effects model was employed, and the effect size was pooled as mean differences with corresponding 95% confidence intervals. A P < 0.05 was considered statistically significant in all cases.

Research results

The success rate of LBBP-CRT was observed to be 91.1% in our analysis. LBBP-CRT resulted in increased LVEF, reduction in LVEDD, and LVESD compared to BiVP-CRT. Significantly reduced BNP levels, and NYHA class was also noted in the LBBP-CRT group vs BiVP-CRT group. Lastly, the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Research conclusions

Our analysis compared success rate, echocardiographic parameters and clinical response between LBBP-CRT vs BiVP-CRT and demonstrated LBBP-CRT to result in significantly improved cardiac echocardiographic parameters, and clinical outcomes when compared to BiVP-CRT.

Research perspectives

LBBP-CRT resulting in significant improvement in the echocardiographic parameters and clinical outcomes can help shape the clinical practice. Further larger randomized control trials are needed.