Introduction
Heart failure is a global health problem, with over 64 million patients
worldwide and over one million hospitalizations annually in the United
States alone1, 2. Heart failure with reduced ejection
fraction (HFrEF) can be associated withleft and right ventricle
desynchrony, which is hemodynamically disadvantageous and related to
increased mortality3. Cardiac resynchronization
therapy (CRT) is an established effective treatment for selected
patients with HFrEF and , abnormal ventricular conduction resulting in
wide QRS complex4-8. Conventionally, CRT is achieved
by right ventricular and left ventricular pacing via coronary sinus
(biventricular pacing, BVP). However, the success rate is highly related
to coronary sinus anatomy (small caliber target vessels, tortuosity, and
coronary sinus valves), and up to 30% of patients do not adequately
respond to BVP CRT5, 9, 10.
Conduction system pacing (CSP), including His bundle pacing (HBP) and
left bundle branch area pacing (LBBP), was introduced in an attempt to
mitigate these challenges by physiologically pacing the His-Purkinje
system. His bundle pacing, however, requires a higher pacing threshold ,
and may not correct left bundle branch block (LBBB) below the level of
His bundle11-14. LBBP was first introduced in 2017 in
humans and has emerged as a feasible and safe alternative to BVP to
achieve cardiac resynchronization with accumulating supporting
data15-18. Hence, the objective of this study was to
conduct a systematic review and meta-analysis of current studies to
compare the efficacy of LBBP and BVP CRT in HFrEF patients.