Key result
Left bundle branch area pacing was superior to His bundle pacing for implant success rate (RR 1.24; 95% CI 1.08-1.42; p=0.002) and pacing metrics as an initial pacing strategy.
Why the study?
Novel pacing technologies such as HBP and LBBaP have emerged to maintain physiological ventricular activation, prompting an investigation into their relative outcomes for de novo permanent pacing.
Does left bundle branch area pacing improve implant success, pacing metrics, and clinical outcomes compared to His bundle pacing in patients requiring de novo permanent pacing?
Meta-Analysis (n=1,596)
Does left bundle branch area pacing improve implant success, pacing metrics, and clinical outcomes compared to His bundle pacing in patients requiring de novo permanent pacing?
LBBaP appears superior to HBP as an initial pacing strategy, offering higher implant success, better pacing metrics, and potentially lower mortality, though randomized data is lacking.
Answers are grounded in this paper and cite their sources.
LBBaP shows better pacing metrics and implant success than HBP; extends evidence supporting LBBaP as initial strategy in conduction-system pacing.
BACKGROUND: Novel pacing technologies, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBaP), have emerged to maintain physiological ventricular activation. We investigated the outcomes of LBBP with HBP for patients requiring a de novo permanent pacing. METHODS AND RESULTS: Systematic review of randomized clinical trials and observational studies comparing LBBaP with HBP until March 01, 2023 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included pacing metrics, QRS duration, lead revision, procedure parameters, all-cause mortality and heart failure hospitalization (HFH). Overall, 10 studies with 1596 patients were included. Implant success rate was higher in LBBaP compared with HBP (RR 1.24, 95% CI: 1.08 to 1.42, p = .002). LBBaP was associated with lower capture threshold at implantation (mean difference (MD) -0.62 V, 95% CI: -0.74 to -0.51 V, p < .0001) and at follow-up (MD -0.74 V, 95% CI: -0.96 to -0.53, p < .0001), shorter procedure duration (MD -14.66 min, 95% CI: -23.54 to -5.78, p = .001) and shorter fluoroscopy time (MD -4.2 min, 95% CI: -8.4 to -0.0, p = .05). Compared with HBP, LBBaP was associated with a decreased risk of all-cause mortality (RR: 0.50, 95% CI: 0.33 to 0.77, p = .002) and HFH (RR: 0.57, 95% CI: 0.33 to 1.00, p = .05). No statistical differences were found in lead revisions and QRS duration before and after pacing. CONCLUSION: This meta-analysis found that LBBaP was superior to HBP regarding pacing metrics and implant success rate as an initial pacing strategy, although absence of head-to-head randomized comparison warrants caution in interpretation of the results.
No takes yet. Share an insight, caveat, or question.
Abdin et al. (2023) conducted a meta-analysis in Patients requiring a de novo permanent pacing (n=1,596). Left bundle branch area pacing (LBBaP) vs. His bundle pacing (HBP) was evaluated on Implant success rate (RR 1.24, 95% CI 1.08 to 1.42, p=.002). Left bundle branch area pacing was superior to His bundle pacing for implant success rate (RR 1.24; 95% CI 1.08-1.42; p=0.002) and pacing metrics as an initial pacing strategy.
Synapse has enriched 10 related papers. Consider them for comparative context: