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Safety and efficacy of His-bundle pacing/left bundle branch area pacing versus right ventricular pacing: a systematic review and meta-analysis

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Abstract

Background

Recent studies have demonstrated that right ventricular pacing (RVP) has deleterious effects on non-synchronized ventricular contraction, while His-bundle pacing (HBP) or left bundle branch area pacing (LBBaP) contribute to improvements in patients’ mid- and long-term outcomes. This meta-analysis aimed to compare the safety and efficacy of physiologic pacing (HBP/LBBaP) versus those of RVP.

Methods

A systematic search of PubMed, Cochrane Library, and Embase was conducted for studies that compared the effects of physiologic pacing and RVP. All eligible studies were published before January 1, 2021 and were conducted in humans. STATA software version 15.0 was used for all the data analyses.

Results

Twenty articles (n = 2787 patients) were included in this meta-analysis. Compared to RVP, physiologic pacing was associated with a significantly shorter QRS duration and better cardiac function. Physiologic pacing was also correlated with lower rates of mitral regurgitation, pacing-induced cardiomyopathy, death, heart failure hospitalization, and atrial fibrillation, although the above results were not statistically significant. In addition, RVP led to the achievement of higher success rates than physiologic pacing, a shorter fluoroscopic time and mean procedure duration, a lower pacing threshold: the results were statistically significant. Compared with HBP, LBBaP appeared to have some advantages in R wave amplitudes, pacing threshold, fluoroscopic time, procedure time, and success rate, with statistically significant differences. Whereas HBP was associated with fewer surgical complications and shorter QRS duration, the results were not statistically significant.

Conclusion

Physiologic pacing (HBP/LBBaP) might be a better strategy than RVP and improve long-term clinical outcomes like cardiac function. Although LBBaP appears to have some advantages over HBP, the long-term benefits are still controversial. More large-scale randomized clinical trials are needed for further verification.

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Acknowledgments

We wanted to thank all the doctors, nurses and staffs who offering help to us. And we would like to thank Editage (www.editage.com) for English language editing.

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Author notes

  1. Xinyi Peng and Yu Chen contributed equally to this work.

Authors and Affiliations

  1. Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Xinyi Peng & Yu Chen

  2. Department of Cardiology, Qindao University Medical College Affiliated Yantaiyuhuangding Hospital, Yantai, China

    Xiaofei Wang & Aizhen Hu

  3. Department of Cardiology, Shandong Provincial Hospital, Shandong, 250021, Jinan, China

    Xuexun Li

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Contributions

Conceptualization: Xinyi Peng. Data curation: Xinyi Peng, Yu Chen, Xiaofei Wang, Xuexun Li. Formal analysis: Xinyi Peng, Yu Chen. Investigation: Xinyi Peng, Yu Chen. Methodology: Xinyi Peng, Yu Chen. Project administration: Xinyi Peng, Yu Chen. Resources: Xinyi Peng, Yu Chen, Xiaofei Wang, Aizhen Hu, Xuexun Li. Software: Xinyi Peng, Yu Chen. Supervision: Yu Chen, Xinyi Peng, Xuexun Li. Validation: Xuexun Li. Writing ± original draft: Xinyi Peng, Yu Chen. Writing ± review and editing: Xinyi Peng, Yu Chen, Xiaofei Wang, Aizhen Hu, Xuexun Li.

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Correspondence to Xuexun Li.

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The authors declared that they had no conflict of interest. All analyses were based on previous published studies; thus, no ethical approval and patient consent were required.

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Supplementary Information

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10840_2021_998_MOESM1_ESM.docx

Supplementary Table 1 Search Strategies. Search included: PUBMED, EMBASE, COCHRANE: search date was from the inception through January 2021. 1) PubMed search strategy. 2) Embase search strategy. 3) Cochrane search strategy. Supplementary Table 2 Quality assessment of included studies. Supplementary Table 3 Actual event rates or values. a. Dichotomous outcomes. b.Continuous variables. Supplementary Figure 1 Publication Bias-Funnel plot for studies evaluating pacing threshold. The Egger’s test showed that p value was 0.684.entary file1 (DOCX 100 KB)

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Peng, X., Chen, Y., Wang, X. et al. Safety and efficacy of His-bundle pacing/left bundle branch area pacing versus right ventricular pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 62, 445–459 (2021). https://doi.org/10.1007/s10840-021-00998-w

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