Essential Site Maintenance: Authorea-powered sites will be updated circa 15:00-17:00 Eastern on Tuesday 5 November.
There should be no interruption to normal services, but please contact us at [email protected] in case you face any issues.

loading page

Reverse left ventricular remodeling with left bundle branch area pacing in heart failure patients with dyssynchrony: Systematic Review and Meta-Analysis
  • +6
  • Noppachai Siranart,
  • Ronpichai Chokesuwattanaskul,
  • Narut Prasitlumku,
  • Anurut Huntrakul,
  • Tanattida Phanthong,
  • Walit Sowalertrat,
  • Leenhapong Navaravong,
  • Wisit Cheungpasitporn,
  • Krit Jongnarangsin
Noppachai Siranart
Chulalongkorn University Faculty of Medicine

Corresponding Author:[email protected]

Author Profile
Ronpichai Chokesuwattanaskul
Chulalongkorn University
Author Profile
Narut Prasitlumku
University of California Riverside
Author Profile
Anurut Huntrakul
Chulalongkorn University
Author Profile
Tanattida Phanthong
Chulalongkorn University Faculty of Medicine
Author Profile
Walit Sowalertrat
Chulalongkorn University Faculty of Medicine
Author Profile
Leenhapong Navaravong
The University of Utah School of Medicine
Author Profile
Wisit Cheungpasitporn
Mayo Clinic Rochester
Author Profile
Krit Jongnarangsin
University of Michigan Michigan Medicine
Author Profile

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.