Reverse left ventricular remodeling with left bundle branch area
pacing in heart failure patients with dyssynchrony: Systematic Review
and Meta-Analysis
Background: Left bundle branch area pacing (LBBAP) has recently
become a promising option for the near-natural restoration of electrical
activation. However, the clinical relevance of therapeutic effects in
individuals with heart failure with reduced ejection fraction (HFrEF)
and dyssynchrony remains unknown.
Methods & Results: MEDLINE, EMBASE, and Cochrane databases
were searched from inception until June 2022. Data from each study was
combined using a random-effects model, the generic inverse variance
method of DerSimonian and Laird, to calculate standard mean differences
and pooled incidence ratio, with 95% confidence intervals (CI). A total
of 772 HFrEF patients were analyzed from 15 observational studies per
protocol. The success rate of LBBAP implantation was 94.8% (95% CI
89.9 to 99.6, I2 = 79.4%), which was strongly correlated with
shortening QRS duration after LBBAP implantation, with a mean difference
of −48.10 msec (95% CI −60.16 to −36.05, I2 = 96.7%). Over a
period of 6–12 months of follow-up, pacing parameters were stable over
time. There were significant improvements in left ventricular ejection
fraction (LVEF), left ventricular end-systolic volume (LVESV), left
ventricular end-diastolic diameter (LVEDD), and left ventricular
end-diastolic volume (LVEDV) with mean difference of 16.38% (95% CI
13.13 to 19.63 I2 = 90.2 %), −46.23 mL (95% CI −63.17 to
−29.29, I2 = 86.82%), −7.21 mm (95% CI −9.71 to −4.71,I2 = 84.6%), and −44.52 mL (95% CI −64.40 to −24.64, I2= 85.9 %), respectively.
Conclusions: LBBAP was associated with improvements in both
cardiac function and electrical synchrony. The benefits of LBBAP in
individuals with HFrEF and dyssynchrony should be further validated by
randomized studies.
Keywords: left bundle branch area pacing, reverse left
ventricular remodeling, heart failure, cardiac resynchronization
therapy, pacing-induced cardiomyopathy