Left bundle branch area pacing was associated with lower heart failure-related hospitalizations compared with biventricular pacing (19.05% vs. 30.00%) and improved electrical synchrony.
Systematic Review (n=5,680)
Does left bundle branch area pacing improve cardiac function, electrical synchrony, and clinical outcomes compared to conventional pacing in heart failure patients with LVEF ≤ 50%?
LBBAP is a promising and safe physiological pacing alternative that improves electrical synchrony and left ventricular ejection fraction in heart failure patients, though large-scale randomized trials are needed to confirm long-term efficacy.
Absolute Event Rate: 19.05% vs 30%
ABSTRACT Background Left bundle branch area pacing (LBBAP) is an emerging physiological pacing technique that restores ventricular electrical synchrony by directly engaging the left conduction system. It has been proposed as an alternative to conventional pacing strategies, particularly in heart failure patients with reduced left ventricular ejection fraction (LVEF ≤ 50%). Methods A systematic literature search of PubMed, MEDLINE, and Scopus was conducted up to December 2024 in accordance with PRISMA guidelines. Sixteen studies involving 5680 patients were included. Reported outcomes included changes in LVEF, QRS duration (QRSd), hospitalization rates, complications, and mortality. Due to heterogeneity among studies, a qualitative narrative synthesis was performed. Results LBBAP was associated with significant improvements in cardiac function, with most studies reporting increased LVEF and marked reductions in QRSd, indicating improved electrical synchrony. Complication rates were low, with rare events such as pneumothorax and lead dislodgement. Heart failure–related hospitalizations were lower with LBBAP compared with biventricular pacing (19.05% vs. 30.00%), while mortality rates remained low across pacing strategies. Overall, LBBAP demonstrated superior electrical resynchronization and favorable clinical outcomes compared with conventional pacing modalities. Conclusion LBBAP is a promising pacing strategy that improves electrical synchrony and cardiac function with a favorable short‐ to mid‐term safety profile. Further large‐scale randomized studies are needed to establish its long‐term efficacy and safety.
Siddiqui et al. (Mon,) conducted a systematic review in Heart failure with reduced left ventricular ejection fraction (n=5,680). Left bundle branch area pacing (LBBAP) vs. Biventricular pacing was evaluated on Heart failure-related hospitalizations. Left bundle branch area pacing was associated with lower heart failure-related hospitalizations compared with biventricular pacing (19.05% vs. 30.00%) and improved electrical synchrony.