Myocardial work parameters in left bundle branch area pacing versus other pacing techniques: a systematic review and aggregate comparative analysis

Cardiac conduction disease often necessitates permanent pacemaker implantation. While right ventricular pacing (RVP) effectively treats bradycardia, it may lead to adverse cardiac remodeling and heart failure. Left bundle branch area pacing (LBBAP) has emerged as an alternative, potentially preserving myocardial function. Non-invasive myocardial work (MW) assessment provides valuable insights into left ventricular systolic function, energetics, and efficiency. This study systematically reviewed and analyzed MW parameters, comparing LBBAP to RVP and His bundle pacing (HBP). A meta-analysis of 241 patients across five studies examined four MW parameters-Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE)-at baseline, post-implantation, and last follow-up (median: 180 days, IQR: 7-360 days). At baseline, MW parameters were similar between LBBAP and RVP. Post-implantation, LBBAP preserved MW more effectively, showing significantly higher GWI than RVP (2250.0 ± 400.0 vs. 1600.0 ± 300.0 mmHg%, p = 0.027), a difference that remained significant at follow-up (p = 0.035). GWE was also significantly higher at follow-up (p = 0.011), while GCW and GWW showed no significant differences. MW parameters did not differ significantly between LBBAP and HBP (all p-values >0.05). These findings suggest that LBBAP provides superior MW preservation compared to RVP, with significant benefits in GWI and GWE, while demonstrating comparable performance to HBP.