His-Purkinje conduction system pacing for pacing-induced cardiomyopathy: a systematic literature review and meta-analysis.

BACKGROUND

Upgrading to His-Purkinje conduction system pacing (HPCSP) has been proven to reverse ventricular remodeling and improve cardiac function in patients with pacing-induced cardiomyopathy (PICM). This meta-analysis aimed to assess the efficacy and clinical benefit of upgrading to HPCSP in patients with PICM after chronic right ventricular pacing (RVP).

METHODS

We systematically searched PubMed, Cochrane Library, and Embase for relevant articles from databases' establishment to April 22, 2022. Clinical outcomes and pacing parameters included left ventricular ejection fraction (LVEF) pre-RVP, pre-HPCSP, and during follow-up, New York Heart Association (NYHA) functional class at baseline and follow-up, lead-related complications, heart failure hospitalization (HFH), all-cause mortality, pacing thresholds at implant and during follow-up, and QRS duration (QRSd) pre-RVP, pre-HPCSP, and during follow-up.

RESULTS

A total of 6 articles including 144 patients were enrolled in this meta-analysis. QRSd increased from 127 ± 29 ms at baseline to 175 ± 19 ms (P < 0.001) during RVP and then significantly narrowed to 116 ± 18 ms (P < 0.001) after upgrading to HPCSP. During a mean follow-up of 17.9 ± 10.5 months, LVEF improved from 35 ± 8% pre-HPSCP to 48 ± 12% after upgrading to HPCSP (P < 0.001). The capture thresholds were 1.2 ± 0.9 V at baseline and increased slightly during follow-up. NYHA functional class improved significantly from 2.7 ± 0.8 to 1.9 ± 0.8 during follow-up (P < 0.001).

CONCLUSION

Our meta-analysis indicates that upgrading to HPCSP in patients with PICM is feasible and efficient, as it significantly improves electrical synchrony and cardiac function.