左束支区域起搏治疗心力衰竭：系统评价和荟萃分析及荟萃回归。

Left bundle branch area pacing in heart failure: A systematic review and meta-analysis with meta-regression.

机构信息

Department Internal Medicine, Eastern Connecticut Health Network, Manchester, Connecticut, USA.

Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA.

出版信息

J Cardiovasc Electrophysiol. 2024 Aug;35(8):1536-1547. doi: 10.1111/jce.16304. Epub 2024 May 29.

DOI:10.1111/jce.16304

PMID:38812213

Abstract

INTRODUCTION

Left bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).

OBJECTIVES

The study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP).

BACKGROUND

Cardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT.

METHOD

A search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta-analysis version 4 was used for meta-regression to examine variables that contribute to data heterogeneity.

RESULT

Eighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: -47.23 ms 95% confidence interval [CI]: -53.45, -41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: -1.23, 95% CI: -1.41, -1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: -20.69 ms, 95% CI: -25.49, -15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all-cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP.

CONCLUSION

LBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes.

摘要

简介

左束支区域起搏是双心室起搏的替代方法。本研究旨在总结左束支阻滞区域起搏（LBBAP）的可行性、疗效和安全性的现有证据。

目的

本研究总结了左束支阻滞区域起搏（LBBAP）的可行性、疗效和安全性的现有证据。

背景

心脏再同步治疗（CRT）降低了左心室射血分数（LVEF）≤35%和伴有左束支传导阻滞（LBBB）的心力衰竭（HF）患者的死亡率和住院率。最近，左束支区域起搏已被研究作为实现 CRT 的更生理性替代方法。

方法

对 PubMed、EMBASE 和 Cochrane 数据库进行了检索，以确定研究左束支区域起搏在心力衰竭 CRT 中的作用的研究。综合荟萃分析版本 4 用于元回归分析，以检查导致数据异质性的变量。

结果

共检查了 18 项研究，其中 17 项为观察性研究，1 项为随机对照试验（RCT）。共纳入 3906 例接受 CRT（2036 例 LBBAP 与 1870 例双心室起搏[BVP]）的 HF 患者。90.4%的患者成功进行了 LBBAP。与基线相比，LBBAP 与 QRS 持续时间缩短（MD：-47.23ms，95%置信区间[CI]：-53.45，-41.01）、LVEF 增加（MD：15.22%，95% CI：13.5，16.94）和 NYHA 分级降低（MD：-1.23，95% CI：-1.41，-1.05）相关。与 BVP 相比，LBBAP 与 QRS 持续时间显著缩短（MD：-20.69ms，95% CI：-25.49，-15.88）和 LVEF 改善（MD：4.78%，95% CI：3.30，6.10）相关。此外，与 BVP 相比，LBBAP 与 HF 住院（比值比[OR]：0.44，95% CI：0.34，0.56）和全因死亡率（OR：0.67，95% CI：0.52，0.86）显著降低相关。