Efficacy and safety of left bundle branch pacing compared with left ventricular septal pacing: A systematic review and meta-analysis

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-09-01 DOI:10.1016/j.hroo.2025.06.006

Iwan Cahyo Santosa Putra MD, Raymond Pranata MD, Mohammad Iqbal MD, PhD, FHRS, Giky Karwiky MD, Chaerul Achmad MD, PhD

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Abstract

Background

Although numerous studies have compared the efficacy and safety of left bundle branch pacing (LBBP) and left ventricular (LV) septal pacing (LVSP), the results remain inconclusive.

Objective

This meta-analysis aimed to systematically compare the efficacy and safety of LBBP with that of LVSP.

Methods

A comprehensive literature search was conducted across PubMed, Europe PMC, and ScienceDirect to identify studies comparing procedural duration, complications, electrophysiological and echocardiographic parameters, and clinical outcomes between LBBP and LVSP.

Results

A total of 22 cohort studies, involving 1360 LBBP and 1186 LVSP procedures, were included. The paced QRS duration (mean difference [MD] = −9.65 ms; 95% confidence interval [CI], −13.35 to −5.96; I² = 84.9%; P < .001) and stimulus-to-LV activation time (MD = −14.62 ms; 95% CI, −16.99 to −12.24; I² = 77.2%; P < .001) were significantly shorter in the LBBP group. In patients with reduced LV ejection fraction (LVEF) and wide QRS duration, the improvement in LVEF was significantly greater in the LBBP group (MD = 6.05%; 95% CI, 2.9–9.2; I² = 51.3%; P < .001). In addition, the LBBP group demonstrated a significant reduction in the risk of all-cause mortality and/or heart failure hospitalization (risk ratio = 0.28; 95% CI, 0.17–0.48; I² = 0%; P < .001). In patients with preserved LVEF and narrow QRS duration, postpacemaker implantation LVEF and LV end-diastolic diameter and the risk of heart failure hospitalization were comparable between the 2 groups. Furthermore, procedural duration, complications, and pacing parameters (sensing amplitude, capture threshold, and lead impedance) did not significantly differ between the groups.

Conclusion

In patients with reduced LVEF and wide QRS duration, LBBP demonstrates superior efficacy compared with LVSP. In contrast, in patients with preserved LVEF and narrow QRS duration, the efficacy of LBBP and LVSP is similar. Both groups exhibit comparable safety profiles and procedural efficiency.

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与左室间隔起搏相比，左束支起搏的有效性和安全性：一项系统回顾和荟萃分析

虽然有大量研究比较了左束支起搏（LBBP）和左室（LV）间隔起搏（LVSP）的有效性和安全性，但结果仍然没有定论。目的系统比较LBBP与LVSP的疗效和安全性。方法在PubMed、Europe PMC和ScienceDirect上进行全面的文献检索，以确定比较LBBP和LVSP的手术时间、并发症、电生理和超声心动图参数以及临床结果的研究。结果共纳入22项队列研究，涉及1360例LBBP和1186例LVSP手术。节律性QRS持续时间（平均差[MD] =−9.65 ms； 95%可信区间[CI]，−13.35 ~−5.96;I2 = 84.9%; P < .001）和刺激-左室激活时间（MD =−14.62 ms; 95% CI,−16.99 ~−12.24;I2 = 77.2%; P < 001）在LBBP组显著缩短。在低左室射血分数（LVEF）和宽QRS持续时间的患者中，LBBP组LVEF的改善显著大于LBBP组（MD = 6.05%; 95% CI, 2.9-9.2; I2 = 51.3%; P < 0.001）。此外，LBBP组显示全因死亡率和/或心力衰竭住院的风险显著降低（风险比= 0.28;95% CI, 0.17-0.48; I2 = 0%; P < 0.001）。在LVEF保留且QRS持续时间较短的患者中，起搏器植入后LVEF和左室舒张末期内径以及心力衰竭住院风险在两组之间具有可比性。此外，手术时间、并发症和起搏参数（感应振幅、捕获阈值和导联阻抗）在两组之间没有显著差异。结论在LVEF降低、QRS持续时间较宽的患者中，LBBP的疗效优于LVSP。相比之下，在保留LVEF和QRS持续时间较短的患者中，LBBP和LVSP的疗效相似。两组均表现出相当的安全性和程序效率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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