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Meta-Analysis
. 2023 Jul;46(7):713-720.
doi: 10.1002/clc.24028. Epub 2023 May 5.

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

Ga-In Yu  1 , Tae-Hoon Kim  2 , Yun-Ho Cho  1 , Jae-Seok Bae  1 , Jong-Hwa Ahn  1 , Jeong Yoon Jang  1 , Yong Whi Park  1 , Choong Hwan Kwak  1
Affiliations
Meta-Analysis

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

Ga-In Yu et al. Clin Cardiol. 2023 Jul.

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.

Keywords: QRS duration; cardiac resynchronization therapy; heart failure with mildly reduced ejection fraction; left bundle branch area pacing; left ventricular ejection fraction; meta-analysis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of selection process for articles included in the meta‐analysis.
Figure 2
Figure 2
Forest plot for the meta‐analysis comparing impact of LBBAP on QRS duration and LVEF. (A) Changes in QRS duration before and after LBBAP. (B) Changes in LVEF before and after LBBAP. Plot demonstrating significant reduction in QRS duration and significant improvement in LVEF. Square data markers represent mean diference of QRS duration (A) and LVEF (B) between pre implantation and postimplantation, and horizontal lines represent 95% CIs. CI, confidence interval; LBBAP, left bundle branch area pacing; LVEF, left ventricular ejection fraction; SD, standard deviation.
Figure 3
Figure 3
Average LVEF from implant to follow‐up for baseline LVEF between 35% and 50% versus LVEF <35%. Both HFrEF and HFmrEF exhibited significant improvements in LVEF after LBBAP. HFmrEF, heart failure with mildly reduced ejection fraction; HFrEF, heart failure with reduced ejection fraction; LBBAP, left bundle branch area pacing; LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

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