Conduction system pacing is superior to biventricular pacing in patients with heart failure: Insights from the pooled clinical studies

Frontiers in Physiology

Physiology

Lei Zhang¹  Jie Zhang¹  Feng Li¹  Qi Kong¹  Yu-Heng Ye¹  Xu-Fei Chen¹  Fan Yang¹  Jia-Yi Chen¹  Zhi-Yuan Zhang¹  Huan-Huan Liu¹  Ru-Xing Wang² 

[1] Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China;null;

关键词: left bundle branch area pacing;    cardiac resynchronization therapy;    biventricular pacing;    heart failure;    his bundle pacing (HBP);   

DOI  :  10.3389/fphys.2023.1125340

 received in 2022-12-16, accepted in 2023-04-26,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background: The effects of conduction system pacing (CSP) compared with conventional biventricular pacing (BVP) on heart function in patients with heart failure remain elusive.Methods: PubMed, Embase, Cochrane’s Library and Web of science databases were searched up to 1 October 2022 for pertinent controlled studies. Random or fixed-effect model were used to synthesize the clinical outcomes. Subgroup analysis was performed to screen the potential confounding factors.Results: Fifteen studies including 1,347 patients were enrolled. Compared with BVP, CSP was significantly associated with shortened QRS duration [WMD -22.51 ms; p = 0.000], improved left ventricular ejection fraction [WMD 5.53%; p = 0.000], improved NYHA grade [WMD -0.42; p = 0.000], higher response rate and lower heart failure rehospitalization rate. CSP resulted in better clinical outcomes in higher male proportion group than lower one compared with BVP. No significant differences of clinical outcomes were observed between left bundle branch area pacing (LBBaP) and his bundle pacing (HBP) except the pacing threshold. The pacing threshold of LBBaP was significantly lower than those in BVP and HBP.Conclusion: This study suggests that CSP might be superior to conventional BVP for HF patients. In a higher male proportion group, CSP may be associated with more benefits than BVP.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022355991; Identifier: CRD42022355991.

【 授权许可】

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Copyright © 2023 Zhang, Li, Zhang, Yang, Kong, Chen, Zhang, Liu, Chen, Ye and Wang.