Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

Ezzeddine, Fatima; Pistiolis, Serafim M.; Pujol‐López, Margarida; Lavelle, Michael T.; Wan, Elaine; Patton, Kristen K.; Robinson, Melissa; Lador, Adi; Tamirisa, Kamala P.; Karim, Saima; Linde, Cecilia; Parkash, Ratika; Birgersdotter‐Green, Ulrika; Russo, Andrea M.; Chung, Mina K.; Cha, Yong‐Mei

doi:10.1016/j.hrthm.2023.02.018

Cited by 22 publications

(26 citation statements)

References 49 publications

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“…From these studies, 26 were selected for an in-depth review after exclusion of single arm studies. Twenty-one studies, including 17 observational studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 4 RCTs, [31][32][33][34][35] reporting the primary outcomes of interest were included in the final meta-analysis (Figure 1). Of note, the randomized trials by Lustgarten et al 36 and Huang et al 37 were not included in the final analysis as these studies were crossover studies, which were unable to be incorporated into meta-analyses as previously stated.…”

Section: Resultsmentioning

confidence: 99%

Clinical outcomes of conduction system pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Kim

Ellenbogen

et al. 2023

Cardiovasc electrophysiol

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IntroductionConduction system pacing (CSP) is observed to produce greater improvements in echocardiographic and hemodynamic parameters as compared to conventional biventricular pacing (BiVP). However, whether these surrogate endpoints directly translate to improvements in hard clinical outcomes such as death and heart failure hospitalization (HFH) with CSP remains uncertain as studies reporting these outcomes are scarce. The aim of this meta‐analysis was to analyze the existing data to compare the clinical outcomes of CSP versus BiVP.MethodsA systematic search of the Embase and PubMed database was performed for studies comparing CSP and BiVP for patients indicated to receive a CRT device. The coprimary endpoints were all‐cause mortality and HFH. Other secondary outcomes included change in left ventricular ejection fraction (LVEF), change in NYHA class, and increase in NYHA class ≥1. A random‐effects model was chosen a priori to analyze the composite effects given the anticipated heterogeneity of included trials.ResultsTwenty‐one studies (4 randomized and 17 observational) were identified reporting either primary outcome and were included in the meta‐analysis. In total 1960 patients were assigned to CSP and 2367 to BiVP. Median follow‐up time was 10.1 months (ranging 2–33 months). CSP was associated with a significant reduction in all‐cause mortality (odds ratio [OR] 0.68, 95% confidence interval [CI]: 0.56–0.83) and HFH (OR 0.52, 95% CI: 0.44–0.63). Mean improvement in LVEF was also greater with CSP (mean difference 4.26, 95% CI: 3.19–5.33). Reduction in NYHA class was significantly greater with CSP (mean difference −0.36, 95% CI: −0.49 to −0.22) and the number of patients with an increase in NYHA class ≥1 was significantly greater with CSP (OR 2.02, 95% CI: 1.70–2.40).ConclusionsCSP was associated with a significant reduction in all‐cause mortality and HFH when compared to conventional BiVP for CRT. Further large‐scale randomized trials are needed to verify these observations.

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Section: Resultsmentioning

confidence: 99%

Clinical outcomes of conduction system pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Kim

Ellenbogen

et al. 2023

Cardiovasc electrophysiol

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“…The systematic search identified 37 eligible publications, 4–8,18–49 including 20 comparative studies—among which four were randomized controlled trials—and 17 single‐arm investigations reporting outcomes in patients undergoing CSP for CRT (details shown in Figure 1). The comparative studies enabled network meta‐analyses of the three interventions—His‐CRT, LBB‐CRT, and BiV‐CRT.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Tavolinejad,

Kazemian,

Bozorgi

et al. 2023

Cardiovasc electrophysiol

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IntroductionCardiac resynchronization therapy (CRT) with biventricular pacing (BiV‐CRT) is ineffective in approximately one‐third of patients. CRT with Conduction system pacing (CSP‐CRT) may achieve greater synchronization. We aimed to assess the effectiveness of CRT with His pacing (His‐CRT) or left bundle branch pacing (LBB‐CRT) in lieu of biventricular CRT.Methods and ResultsThe PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were systematically searched until August 19, 2023, for original studies including patients with reduced left ventricular ejection fraction (LVEF) who received His‐ or LBB‐CRT, that reported either CSP‐CRT success, LVEF, QRS duration (QRSd), or New York Heart Association (NYHA) classification. Effect measures were compared with frequentist network meta‐analysis. Thirty‐seven publications, including 20 comparative studies, were included. Success rates were 73.5% (95% CI: 61.2–83.0) for His‐CRT and 91.5% (95% CI: 88.0–94.1) for LBB‐CRT. Compared to BiV‐CRT, greater improvements were observed for LVEF (mean difference [MD] for His‐CRT +3.4%; 95% CI [1.0; 5.7], and LBB‐CRT: +4.4%; [2.5; 6.2]), LV end‐systolic volume (His‐CRT:17.2mL [29.7; 4.8]; LBB‐CRT:15.3mL [28.3; 2.2]), QRSd (His‐CRT: –17.1ms [–25.0; –9.2]; LBB‐CRT: –17.4ms [–23.2; –11.6]), and NYHA (Standardized MD [SMD]: His‐CRT:0.4 [0.8; 0.1]; LBB‐CRT:0.4 [–0.7; –0.2]). Pacing thresholds at baseline and follow‐up were significantly lower with LBB‐CRT versus both His‐CRT and BiV‐CRT. CSP‐CRT was associated with reduced mortality (R = 0.75 [0.61–0.91]) and hospitalizations risk (RR = 0.63 [0.42–0.96]).ConclusionThis study found that CSP‐CRT is associated with greater improvements in QRSd, echocardiographic, and clinical response. LBB‐CRT was associated with lower pacing thresholds. Future randomized trials are needed to determine CSP‐CRT efficacy.

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“…10 There are observational and retrospective data suggesting that left bundle branch area pacing may be as good or better than CRT in improving clinical outcomes and heart function. 11,12 Further, with experience, it is potentially faster to implant a left bundle area lead compared to a coronary sinus lead, and there has been wide early adoption of the technique compared to His bundle pacing. A multi-center, randomized controlled trial evaluating conduction system pacing compared to CRT should start enrolling soon and we should have more information in the coming years.…”

mentioning

confidence: 99%

Defining dyssynchrony: The ongoing search for cardiac resynchronization therapy “response”

Mareddy

Mason

2023

Preprint

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Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

Cited by 22 publications

References 49 publications

Clinical outcomes of conduction system pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Clinical outcomes of conduction system pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta‐analysis

Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta‐analysis

Defining dyssynchrony: The ongoing search for cardiac resynchronization therapy “response”

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