His‐Purkinje conduction system pacing: A systematic review and network meta‐analysis in bradycardia and conduction disorders

Abstract

Background His‐Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). Methods A Bayesian random‐effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until September 21, 2021. Results Twenty‐eight studies involving 4160 patients were included in this meta‐analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R‐wave amplitude compared with HBP. LBBP also demonstrated a nonsignificant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all‐cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rates, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. Conclusions This network meta‐analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger‐scale, long‐term comparative studies are warranted for further verification.

Utility of a guiding catheter for conduction system pacing: An early multicenter experience

“… 2 , 3 , 17 , 18 , 25 However, many publications reported much lower HBP implant success (63%–85%), especially in patients with left bundle branch block. 10 , 12 , 15 , 26 , 27 If CSP is to play a significant role in the world of pacing, it must be applicable outside highly specialized centers. In the present study, of the 10 cases in which no CSP could be established, 8 occurred in centers that had never tried LBBAP, and 1 case occurred in a center that had never tried HBP.…”

“… 1 , 2 , 3 , 4 , 5 Alternatively, pacing at the bundle of His or in the left bundle branch area directly stimulates parts of the cardiac conduction system and is collectively referred to as conduction system pacing (CSP). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 CSP is attracting increasing attention because it maintains the physiological contraction pattern and better preserves the mechanical function of the ventricles.…”

Long-term outcomes of TAVI patients undergoing different pacing modality: LBBAP versus RVP

“…Conduction system pacing, mainly utilizing His bundle pacing (HBP) and LBBAP, has been shown to achieve excellent electrical synchrony, and have the potential to prevent pacing-induced cardiomyopathy and the subsequent heart failure [19][20][21]. It is worth noticing that previous studies demonstrated a much higher feasibility of LBBAP than HBP in patients undergoing TAVI, characterized by higher success rate and lower pacing threshold [13,22].…”

Beneficial effects of upgrading to His-Purkinje system pacing in patients with pacing-induced cardiomyopathy: a systematic review and meta-analysis

“…A series of studies have shown that HBP can produce favorable clinical outcomes in patients with CRT indications ( Shan et al, 2018 ; Qu et al, 2021 ). The HIS-SYNC trial showed that HBP resulted in a shorter QRSd and was equally effective in improving cardiac function, including LVEF and NYHA classification compared to CRT ( Upadhyay et al, 2019 ).…”