Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta‐analysis

Abstract

Cardiac resynchronization therapy (CRT) strategy for heart failure with mildly reduced ejection fraction (HFmrEF) is controversial. Left bundle branch area pacing (LBBAP) is an emerging pacing modality and an alternative option to CRT. This analysis aimed to perform a systematic review of the literature and meta-analysis on the impact of the LBBAP strategy in HFmrEF, with left ventricular ejection fraction (LVEF) between 35% and 50%. PubMed, Embase, and Cochrane Library were searched for full-text articles on LBBAP from inception to July 17, 2022. The outcomes of interest were QRS duration and LVEF at baseline and follow-up in mid-range heart failure. Data were extracted and summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Out of 1065 articles, 8 met the inclusion criteria for 211 mid-range heart failure patients with an implant LBBAP across the 16 centers. The average implant success rate with lumenless pacing lead use was 91.3%, and 19 complications were reported among all 211 enrolled patients. During the average follow-up of 9.1 months, the average LVEF was 39.8% at baseline and 50.5% at follow-up (MD: 10.90%, 95% CI: 6.56−15.23, p < .01). Average QRS duration was 152.6 ms at baseline and 119.3 ms at follow-up (MD: −34.51 ms, 95% CI: −60.00 to −9.02, p < .01). LBBAP could significantly reduce QRS duration and improve systolic function in a patient with LVEF between 35% and 50%. Application of LBBAP as a CRT strategy for HFmrEF may be a viable option.

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy

“…In patients with HR and mildly reduced LVEF associated with pacing-induced cardiomyopathy or intraventricular conduction anomalies, the use of LBBAP seems to be associated with a significant improvement in LVEF and a reduction in QRS duration. [ 50 ] Unfortunately, there are no direct comparisons between LBBAP and other pacing strategies (HBP, RV pacing or standard BiVp) in this group of patients.…”

Detailed One-Year Follow-Up in Left Bundle Branch Area Pacing: Echocardiography, Natriuretic Peptide, Electrical Parameters and Complications

“…The main advantage of LBBAP is the provision of better ventricular synchrony than in conventional right ventricular pacing (RVP) [ 6 ]. The superior outcomes of LBBAP compared to RVP in heart failure hospitalization and all-cause mortality rates, as well as in various parameters of cardiac function, have been shown in a few studies [ 7 , 8 , 9 ]. The mechanism underlying these results is fast activation of the left ventricle by left bundle branch (LBB) fibres or via quick capture of the left side of the septal myocardium.…”

Observational Study of Left Bundle Branch Area Pacing: Implantation of the Solia S Lead using the Selectra 3D Sheath at an Inclined Angle

“…In contrast, traditional right ventricular apical pacing falls short in simulating normal cardiac conduction and has been linked to elevated risks of heart failure and atrial brillation (1)(2)(3). LBBaP, which targets the left bundle branch area, offers a superior approximation of natural cardiac conduction, and mitigates conduction disparities across different ventricular walls (4,5)C Consequently, it holds signi cant promise for clinical applications.…”