Conduction system pacing is superior to biventricular pacing in patients with heart failure: Insights from the pooled clinical studies

Jie Zhang; Feng Li; Zhiyuan Zhang; Fan Yang; Qi Kong; Jiayi Chen; Lei Zhang; Huan‐Huan Liu; Xufei Chen; Y.-C. Ye; Ruxing Wang

doi:10.3389/fphys.2023.1125340

May 5, 2023Frontiers in PhysiologyOpen Access

Conduction system pacing is superior to biventricular pacing in patients with heart failure: Insights from the pooled clinical studies

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Why the study?

The effects of conduction system pacing compared with conventional biventricular pacing on heart function in patients with heart failure remained elusive.

Does conduction system pacing improve heart function and clinical outcomes compared to conventional biventricular pacing in patients with heart failure?

Key Points

To compare the effects of conduction system pacing against conventional biventricular pacing on cardiac function and clinical outcomes in patients with heart failure.
Systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases through October 1, 2022 (PROSPERO CRD42022355991).
Identified and pooled data from 15 controlled studies comprising 1,347 patients receiving conduction system pacing or biventricular pacing.
Synthesized outcomes using random- or fixed-effects models, with subgroup analyses evaluating pacing subtypes and patient sex distribution.
Conduction system pacing significantly shortened QRS duration (WMD -22.51 ms; p = 0.000) and increased left ventricular ejection fraction (WMD 5.53%; p = 0.000) compared with biventricular pacing.
Conduction system pacing produced greater improvements in NYHA functional class (WMD -0.42; p = 0.000), higher clinical response rates, and lower heart failure rehospitalization rates, with pronounced benefits in cohorts with higher male proportions.
Left bundle branch area pacing achieved significantly lower pacing thresholds than both biventricular pacing and His bundle pacing, while other clinical outcomes did not differ significantly between conduction pacing subtypes.

Structured PICO

Does conduction system pacing improve heart function and clinical outcomes compared to conventional biventricular pacing in patients with heart failure?

P

Population

1,347 patients with heart failure requiring cardiac resynchronization therapy (CRT), pooled from 15 studies (4 randomized controlled studies and 11 non-randomized observational studies).

I

Intervention

Conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBaP).

C

Comparator

Conventional biventricular pacing (BVP).

O

Outcome

Changes in QRS duration, left ventricular ejection fraction (LVEF), NYHA grade, and heart failure rehospitalization rate.surrogate

Limitations

Short follow-up period (mostly 6 to 12 months, only two studies up to 24 months)
Inherent limitations of included studies with small populations (sample size ≤20)
High crossover rate between operation arms in some included studies (e.g., His-SYNC pilot trial)

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Implication

Conduction system pacing provides superior electromechanical resynchronization, improved LVEF, and reduced heart failure hospitalizations compared to traditional biventricular pacing in patients requiring cardiac resynchronization therapy.

Abstract

Background: The effects of conduction system pacing (CSP) compared with conventional biventricular pacing (BVP) on heart function in patients with heart failure remain elusive. Methods: PubMed, Embase, Cochrane’s Library and Web of science databases were searched up to 1 October 2022 for pertinent controlled studies. Random or fixed-effect model were used to synthesize the clinical outcomes. Subgroup analysis was performed to screen the potential confounding factors. Results: Fifteen studies including 1,347 patients were enrolled. Compared with BVP, CSP was significantly associated with shortened QRS duration [WMD -22.51 ms; p = 0.000], improved left ventricular ejection fraction [WMD 5.53%; p = 0.000], improved NYHA grade [WMD -0.42; p = 0.000], higher response rate and lower heart failure rehospitalization rate. CSP resulted in better clinical outcomes in higher male proportion group than lower one compared with BVP. No significant differences of clinical outcomes were observed between left bundle branch area pacing (LBBaP) and his bundle pacing (HBP) except the pacing threshold. The pacing threshold of LBBaP was significantly lower than those in BVP and HBP. Conclusion: This study suggests that CSP might be superior to conventional BVP for HF patients. In a higher male proportion group, CSP may be associated with more benefits than BVP. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022355991 ; Identifier: CRD42022355991.

Discussion

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Cite This Study

Zhang et al. (2023) studied this question.

synapsesocial.com/papers/6a0946a3a9b588564433f6b3 https://doi.org/10.3389/fphys.2023.1125340

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Conduction system pacing is superior to biventricular pacing in patients with heart failure: Insights from the pooled clinical studies

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Conduction system pacing is superior to biventricular pacing in patients with heart failure: Insights from the pooled clinical studies

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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