Effectiveness of bundle of His pacing for cardiac resynchronization therapy in patients with heart failure combined with wide QRS complex: a meta-analysis

Objective: To evaluate systematically the feasibility and effectiveness of His Bundle Pacing (HBP) for cardiac resynchronization therapy.Methods: A comprehensive search was conducted in PubMed, EMbase, WOS, Cochrane Library, Medline, and SinoMed for studies published between December 2003 and December 2023.Primary clinical outcomes included implantation success, QRS wave duration, pacing threshold, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), New York Heart Association (NYHA) cardiac function class, and complications.Data were extracted and summarized, and meta-analysis was performed by Revman 5.3 software.Results: Fourteen studies involving a total of 555 patients were included.The overall success rate for HBP implantation was 83.2% (462/555).Compared to baseline values, QRS duration was significantly reduced (MD=48.29,95% CI: 45.20 to 51.38, P<0.01,I 2 =85%), LVEF was significantly increased (MD=-13.62,95% CI: -15.46 to -11.79, P<0.01,I 2 =74%), LVEDD was smaller (MD=5.83,95% CI: 4.44-7.22,P<0.01,I 2 =78.2%), and NYHA showed significant improvement (MD=1.24,95% CI: 1.14-1.35,P<0.01,I 2 =97.2%).At follow-up, pacing threshold increased (MD=-0.28,95% CI: -0.43 to -0.12, P<0.01,I 2 =0%), and pacing impedance decreased (MD=51.62,95% CI: 23.67 to 79.56, P<0.01,I 2 =56%).Conclusion: HBP is effective for cardiac resynchronization therapy.HBP significantly reduces QRS duration and improves LVEF in heart failure patients.