Reverse left ventricular remodeling with left bundle branch area pacing
in heart failure patients with dyssynchrony: Systematic Review and
Meta-Analysis
Abstract
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,
I2 = 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,
I2 = 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
I2 = 90.2 %), −46.23 mL (95% CI −63.17 to
−29.29, I2 = 86.82%), −7.21 mm (95% CI −9.71
to −4.71, I2 = 84.6%), and −44.52 mL (95% CI
−64.40 to −24.64, I2 = 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.