Conduction system pacing vs. biventricular pacing for cardiac resynchronization therapy in heart failure with reduced ejection fraction: An updated systematic review and meta-analysis
Dhan Bahadur Shrestha , Abinash Baniya , Sandesh Lamichhane , Manoj Shahi , Jurgen Shtembari , Abhishek J. Deshmukh , Dinesh Voruganti , Nimesh Kirit Patel , Kunal Sangal , Saraschandra Vallabhajosyula , Neel J. Patel , Prashant D. Bhave , S. Patrick Whalen , Ghanshyam Shantha
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引用次数: 0
Abstract
Background
Conduction system pacing (CSP) is considered an effective and physiological form of pacing in patients requiring cardiac resynchronization therapy (CRT).
Objective
To compare electrocardiographic (ECG), echocardiographic (ECHO) characteristics and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) undergoing CRT with CSP or biventricular pacing (BVP).
Methods
This study protocol was registered in the PROSPERO registry (CRD42022375155) and the review was conducted per the PRISMA protocol. Four major databases were searched from inception till October 20, 2022, for relevant studies comparing CSP to BVP for CRT in patients with HFrEF.
Results
From a total of 10,072 references identified, 35 full-text were assessed and 18 studies (6 RCTs, 12 observational studies) were included in the review. Following left bundle branch area pacing (LBBAP), on average, paced QRS duration was 28 ms narrower in comparison to BVP (MD -27.69, CI -36.59 to -18.80), and a similar result was obtained with HBP vs. BVP as well. Left ventricular ejection fraction (LVEF) improvement was greater with CSP in comparison to BVP [LBBAP (MD 6.03, CI 4.16–7.91); HBP (MD 3.79, CI 0.46–7.11); HPSP (MD 6.60, CI 4.42–8.78). There were higher odds of being responders (OR 3.82, CI 1.88–7.75)/super responders (OR 2.08, CI 1.53–2.82) (per ECHO findings) in the CSP group, and overall mortality (OR 0.61, CI 0.40–0.93) and hospitalization for HF (HHF) (OR 0.37, CI 0.25–0.55) was lower in CSP group.
Conclusion
Our analysis showed better ECG, ECHO, and clinical outcomes in terms of mortality and HHF with CSP compared to BVP.
背景:传导系统起搏(CSP)被认为是需要心脏再同步化治疗(CRT)的患者有效的生理起搏形式。目的比较心力衰竭伴射血分数降低(HFrEF)患者行CRT与CSP或双心室起搏(BVP)的心电图(ECG)、超声心动图(ECHO)特征及临床结果。方法本研究方案在PROSPERO注册中心注册(CRD42022375155)，并按照PRISMA方案进行审查。从建立到2022年10月20日，我们检索了四个主要数据库，以比较CSP和BVP对HFrEF患者进行CRT治疗的相关研究。结果共纳入10072篇文献，评估了35篇全文，纳入了18项研究(6项随机对照试验，12项观察性研究)。左束支区起搏(LBBAP)后，节律性QRS持续时间平均比BVP缩短28 ms (MD -27.69, CI -36.59至-18.80)，HBP与BVP也获得了类似的结果。与BVP [LBBAP]相比，CSP组左室射血分数(LVEF)改善更大(MD 6.03, CI 4.16-7.91);HBP (md 3.79, ci 0.46-7.11);HPSP (md 6.60, ci 4.42-8.78)。CSP组出现应答者(OR 3.82, CI 1.88-7.75)/超级应答者(OR 2.08, CI 1.53-2.82)(每ECHO结果)的几率更高，且CSP组总死亡率(OR 0.61, CI 0.40-0.93)和HF住院率(OR 0.37, CI 0.25-0.55)较低。结论:我们的分析显示，与BVP相比，CSP患者在死亡率和HHF方面的ECG、ECHO和临床结果更好。
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