Leventopoulos Georgios, Travlos Christoforos K, Anagnostopoulou Virginia, Patrinos Panagiotis, Papageorgiou Angeliki, Perperis Angelos, Gale Chris P, Gatzoulis Konstantinos Α, Davlouros Periklis
Department of Cardiology, General University Hospital of Patras, 26504 Patras, Greece.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.
Rev Cardiovasc Med. 2023 Nov 9;24(11):312. doi: 10.31083/j.rcm2411312. eCollection 2023 Nov.
Biventricular pacing (BVP) is recommended for patients with heart failure (HF) who require cardiac resynchronization therapy (CRT). Left bundle branch area pacing (LBBAP) is a novel pacing strategy that appears to ensure better electrical and mechanical synchrony in these patients. Our aim was to systematically review and meta-analyze the existing evidence regarding the clinical outcomes of LBBAP-CRT compared with BVP-CRT.
Medline, Embase, Cochrane Central Register of Controlled Trials and Web of Science databases were searched for studies comparing LBBAP-CRT with BVP-CRT. Outcomes were all-cause mortality, heart failure hospitalizations (HFH) and New York Heart Association (NYHA) class improvement. We included randomized controlled trials (RCTs) and observational studies with participants that had left ventricular ejection fraction (LVEF) 40% and (i) symptomatic HF or (ii) expected ventricular pacing 40%. Random and fixed effects models pairwise meta-analysis was conducted. Cochrane Risk of Bias 2 assessment tool (ROB 2.0) and the Newcastle-Ottawa scale (NOS) were used to assess the quality of the studies.
Eleven studies (10 observational studies and 1 RCT) with 3141 patients were included in the analysis. Compared with BVP-CRT, LBBAP-CRT was associated with lower risk of all-cause mortality (risk ratio (RR): 0.71, 95% CI: 0.57 to 0.87; = 0.001), lower risk of HFH (RR: 0.59, 95% CI: 0.50 to 0.71; 0.00001) and more improvement in NYHA class (weighed mean difference (WMD): -0.36, 95% CI: -0.59 to -0.13; 0.00001) compared with patients who received BVP-CRT.
Compared with BVP-CRT, receipt of LBBAP-CRT in patients with HF is associated with a lower risk of mortality, and HFH and greater improvement in NHYA class.
对于需要心脏再同步治疗（CRT）的心力衰竭（HF）患者，推荐使用双心室起搏（BVP）。左束支区域起搏（LBBAP）是一种新型起搏策略，似乎能确保这些患者获得更好的电和机械同步性。我们的目的是系统评价和荟萃分析关于LBBAP-CRT与BVP-CRT临床结局的现有证据。
检索Medline、Embase、Cochrane对照试验中央注册库和Web of Science数据库，查找比较LBBAP-CRT与BVP-CRT的研究。结局指标为全因死亡率、心力衰竭住院（HFH）和纽约心脏协会（NYHA）心功能分级改善情况。我们纳入了随机对照试验（RCT）和观察性研究，研究对象为左心室射血分数（LVEF）≤40%且（i）有症状性HF或（ii）预计心室起搏≥40%的参与者。进行随机和固定效应模型的成对荟萃分析。使用Cochrane偏倚风险2评估工具（ROB 2.0）和纽卡斯尔-渥太华量表（NOS）评估研究质量。
分析纳入了11项研究（10项观察性研究和1项RCT），共3141例患者。与BVP-CRT相比，LBBAP-CRT与较低的全因死亡率风险相关（风险比（RR）：0.71，95%置信区间（CI）：0.57至0.87；P = 0.001），较低的HFH风险（RR：0.59，95% CI：0.50至0.71；P < 0.00001），并且与接受BVP-CRT的患者相比，NYHA心功能分级有更大改善（加权平均差（WMD）：-0.36，95% CI：-0.59至-0.13；P < 0.00001）。
与BVP-CRT相比，HF患者接受LBBAP-CRT与较低的死亡率风险、HFH风险以及NYHA心功能分级的更大改善相关。
