Abdin Amr, Werner Christian, Burri Haran, Merino José L, Vukadinović Davor, Sawan Noureddin, Gajek Jacek, Böhm Michael, Ukena Christian
Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany.
Cardiology Department, Geneva University Hospital, Geneva, Switzerland.
Pacing Clin Electrophysiol. 2023 Nov;46(11):1315-1324. doi: 10.1111/pace.14836. Epub 2023 Oct 9.
Novel pacing technologies, such as His bundle pacing (HBP) and left bundle branch area pacing (LBBaP), have emerged to maintain physiological ventricular activation. We investigated the outcomes of LBBP with HBP for patients requiring a de novo permanent pacing.
Systematic review of randomized clinical trials and observational studies comparing LBBaP with HBP until March 01, 2023 was performed. Random and fixed effects meta-analyses of the effect of pacing technology on outcomes were performed. Study outcomes included pacing metrics, QRS duration, lead revision, procedure parameters, all-cause mortality and heart failure hospitalization (HFH). Overall, 10 studies with 1596 patients were included. Implant success rate was higher in LBBaP compared with HBP (RR 1.24, 95% CI: 1.08 to 1.42, p = .002). LBBaP was associated with lower capture threshold at implantation (mean difference (MD) -0.62 V, 95% CI: -0.74 to -0.51 V, p < .0001) and at follow-up (MD -0.74 V, 95% CI: -0.96 to -0.53, p < .0001), shorter procedure duration (MD -14.66 min, 95% CI: -23.54 to -5.78, p = .001) and shorter fluoroscopy time (MD -4.2 min, 95% CI: -8.4 to -0.0, p = .05). Compared with HBP, LBBaP was associated with a decreased risk of all-cause mortality (RR: 0.50, 95% CI: 0.33 to 0.77, p = .002) and HFH (RR: 0.57, 95% CI: 0.33 to 1.00, p = .05). No statistical differences were found in lead revisions and QRS duration before and after pacing.
This meta-analysis found that LBBaP was superior to HBP regarding pacing metrics and implant success rate as an initial pacing strategy, although absence of head-to-head randomized comparison warrants caution in interpretation of the results.
新型起搏技术，如希氏束起搏（HBP）和左束支区域起搏（LBBaP）已出现以维持生理性心室激动。我们研究了对于需要初次永久性起搏的患者，LBBP联合HBP的效果。
对截至2023年3月1日比较LBBaP与HBP的随机临床试验和观察性研究进行系统评价。对起搏技术对结局的影响进行随机和固定效应荟萃分析。研究结局包括起搏指标、QRS波时限、导线修正、手术参数、全因死亡率和心力衰竭住院（HFH）。总体而言，纳入了10项研究共1596例患者。与HBP相比，LBBaP的植入成功率更高（RR 1.24，95% CI：1.08至1.42，p = 0.002）。LBBaP与植入时（平均差值（MD）-0.62 V，95% CI：-0.74至-0.51 V，p < 0.0001）和随访时（MD -0.74 V，95% CI：-0.96至-0.53，p < 0.0001）较低的捕获阈值、较短的手术持续时间（MD -14.66分钟，95% CI：-23.54至-5.78，p = 0.001）和较短的透视时间（MD -4.2分钟，95% CI：-8.4至-0.0，p = 0.05）相关。与HBP相比，LBBaP与全因死亡率（RR：0.50，95% CI：0.33至0.77，p = 0.002）和HFH（RR：0.57，95% CI：0.33至1.00，p = 0.05）风险降低相关。在起搏前后的导线修正和QRS波时限方面未发现统计学差异。
这项荟萃分析发现，作为初始起搏策略，LBBaP在起搏指标和植入成功率方面优于HBP，尽管缺乏直接的随机对照比较，在解释结果时需谨慎。
