Reverse left ventricular remodeling with left bundle branch area pacing in heart failure patients with dyssynchrony: Systematic Review and Meta-Analysis

Background: Left bundle branch area pacing (LBBAP) has recently become a promising option for the near-natural restoration of electrical activation. However, the clinical relevance of therapeutic effects in individuals with heart failure with reduced ejection fraction (HFrEF) and dyssynchrony remains unknown. Methods & Results: MEDLINE, EMBASE, and Cochrane databases were searched from inception until June 2022. Data from each study was combined using a random-effects model, the generic inverse variance method of DerSimonian and Laird, to calculate standard mean differences and pooled incidence ratio, with 95% confidence intervals (CI). A total of 772 HFrEF patients were analyzed from 15 observational studies per protocol. The success rate of LBBAP implantation was 94.8% (95% CI 89.9 to 99.6, I 2 = 79.4%), which was strongly correlated with shortening QRS duration after LBBAP implantation, with a mean difference of −48.10 msec (95% CI −60.16 to −36.05, I 2 = 96.7%). Over a period of 6–12 months of follow-up, pacing parameters were stable over time. There were significant improvements in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) with mean difference of 16.38% (95% CI 13.13 to 19.63 I 2 = 90.2 %), −46.23 mL (95% CI −63.17 to −29.29, I 2 = 86.82%), −7.21 mm (95% CI −9.71 to −4.71, I 2 = 84.6%), and −44.52 mL (95% CI −64.40 to −24.64, I 2 = 85.9 %), respectively . Conclusions: LBBAP was associated with improvements in both cardiac function and electrical synchrony. The benefits of LBBAP in individuals with HFrEF and dyssynchrony should be further validated by randomized studies.