A Randomized Trial of His Pacing Versus Biventricular Pacing in Symptomatic HF Patients With Left Bundle Branch Block (His-Alternative)

Vinther, Michael; Risum, Niels; Svendsen, Jesper Hastrup; Møgelvang, Rasmus; Philbert, Berit Thornvig

doi:10.1016/j.jacep.2021.04.003

Cited by 140 publications

(185 citation statements)

References 13 publications

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“…Seven articles were found to be eligible for the present meta‐analysis after a full‐text review. 11 , 21 , 23 , 33 , 34 , 35 , 36 However, two included studies were from the same center, the patients were included from December 2012 to December 2018, 35 and January 2012 to June 2017, 11 respectively. It seems that some patients included were overlapped, so we determined to delete the study of Huang et al, which included relatively few patients.…”

Section: Resultsmentioning

confidence: 99%

Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta‐analysis

Hua

Wang

Kong

et al. 2022

Clinical Cardiology

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Background:The comparative effects of different types of cardiac resynchronization therapy (CRT) delivered by biventricular pacing (BVP), His bundle pacing (HBP), and left bundle branch area pacing (LBBAP) remain inconclusive.Hypothesis: HBP and LBBAP may be advantageous over BVP for CRT.Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for studies that reported the effects after BVP, HBP, and LBBAP for CRT. The effects between groups were compared by a frequentist random-effects network meta-analysis (NMA), by which the mean differences (MDs) and 95% confidence intervals (CIs) were calculated.Results: Six articles involving 389 patients remained for the final meta-analysis. The mean follow-up of these studies was 8.03 ± 3.15 months. LBBAP resulted in a greater improvement in LVEF% (MD = 7.17, 95% CI = 4.31 to 10.04), followed by HBP (MD = 4.06, 95% CI = 1.09 to 7.03) compared with BVP. HBP resulted in a narrower QRS duration (MD = 31.58 ms, 95% CI = 12.75 to 50.40), followed by LBBAP (MD = 27.40 ms, 95% CI = 10.81 to 43.99) compared with BVP. No significant differences of changes in LVEF improvement and QRS narrowing were observed between LBBAP and HBP. The pacing threshold of LBBAP was significantly lower than those of BVP and HBP. Conclusion:The NMA first found that LBBAP and HBP resulted in a greater LVEF improvement and a narrower QRS duration compared with BVP. Additionally, LBBAP resulted in similar clinical outcomes but with lower pacing thresholds, and may therefore offer advantages than does HBP for CRT.

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Section: Resultsmentioning

confidence: 99%

Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta‐analysis

Hua

Wang

Kong

et al. 2022

Clinical Cardiology

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“…The current potential hypothesis is that LBBP further enriches physiological pacing and may even be more applicable to patients with AVB. Furthermore, Vinther et al (37) found that His bundle improved ventricular function and quality of life, but this was at the cost of a higher pacing threshold. Hou et al (39) found that left bundle branch pacing produced higher R-wave amplitude than HBP and lower capture threshold stability parameters than HBP.…”

Section: Discussionmentioning

confidence: 99%

“…Further details regarding the studies analyzed are shown in Table 1. The 18 included studies (11,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), which were RCTs and observational studies, were scored using the Jadad scoring system and the NOS quality assessment system, as shown in Figures 2A,B.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Clinical Outcomes Associated With His-Purkinje System Pacing vs. Biventricular Pacing, in Cardiac Resynchronization Therapy: A Meta-Analysis

Yang

et al. 2022

Front. Cardiovasc. Med.

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AimsHis-Purkinje system pacing has recently emerged as an alternative to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). The aim of this study was to conduct a meta-analysis comparing the clinical outcomes associated with His-Purkinje system pacing (HPSP) vs. BIVP in patients with heart failure. There is also a comparison of clinical outcomes of His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in the His-Purkinje system.MethodsWe searched the Cochrane Library, Embase, and PubMed, for studies published between January 2010 and October 2021 that compared the clinical outcomes associated with HPSP vs. BIVP and HBP vs. LBBP in HPSP in patients who underwent CRT. The pacing threshold, R-wave amplitudes, QRS duration, New York Heart Association functional (NYHA), left ventricular ejection fraction (LVEF), and LV end-diastolic diameter (LVEDD) of heart failure, at follow-up, were extracted and summarized for meta-analysis.ResultsA total of 18 studies and 1517 patients were included in our analysis. After a follow-up period of 9.3 ± 5.4 months, the HPSP was found to be associated with shorter QRS duration in the CRT population compared to that in the BIVP (SMD, −1.17; 95% CI, −1.56 to −0.78; P < 0.00001; I2 = 74%). No statistical difference was verified between HBP and LBBP on QRS duration (SMD, 0.04; 95% CI, −0.32 to 0.40; P = 0.82; I2 = 84%). In the comparison of HPSP and BIVP, the LBBP subgroup showed improved LVEF (SMD, 0.67; 95% CI, 0.42–0.91; P < 0.00001; I2 = 0%), shorter LVEDD (SMD, 0.59; 95% CI, 0.93–0.26; P = 0.0005; I2 = 0%), and higher New York Heart Association functional class (SMD, −0.65; 95% CI, −0.86 to −0.43; P < 0.00001; I2 = 45%). In terms of pacing threshold and R-wave amplitude clinical outcomes, LBBP has a lower pacing threshold (SMD, 1.25; 95% CI, 1.12–1.39; P < 0.00001; I2 = 47%) and higher R-wave amplitude (MD, −7.88; 95% CI, −8.46 to −7.31; P < 0.00001; I2 = 8%) performance compared to HBP.ConclusionOur meta-analysis showed that the HPSP produced higher LVEF, shorter QRS duration, and higher NYHA functional class in the CRT population than the BIVP as observed on follow-up. LBBP has a lower pacing threshold and higher R-wave amplitude. HPSP may be a new and promising alternative to BIVP in the future.

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“…In a prospective randomized study of HBP versus conventional CRT, HBP resulted in more improved LVEF and LVESV but was limited by high pacing thresholds at 6 months. 87 In a non-randomized study comparing LBAP, HBP, and CS pacing, LBAP and HBP were comparable in regard to LVEF improvement and NYHA class improvement, and both were better than CS pacing. 88 It is only a matter of time before we have results from a prospective randomized trial with long-term efficacy of LBAP versus CS pacing.…”

Section: When Cardiac Resynchronization Therapy Failsmentioning

confidence: 94%

Determinants of Response to Cardiac Resynchronization Therapy

Allison¹,

Biton²,

Mela³

2022

J Innov Cardiac Rhythm Manage.

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A Randomized Trial of His Pacing Versus Biventricular Pacing in Symptomatic HF Patients With Left Bundle Branch Block (His-Alternative)

Cited by 140 publications

References 13 publications

Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta‐analysis

Comparative effects of left bundle branch area pacing, His bundle pacing, biventricular pacing in patients requiring cardiac resynchronization therapy: A network meta‐analysis

Clinical Outcomes Associated With His-Purkinje System Pacing vs. Biventricular Pacing, in Cardiac Resynchronization Therapy: A Meta-Analysis

Determinants of Response to Cardiac Resynchronization Therapy

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