PMID- 37172670
OWN - NLM
STAT- MEDLINE
DCOM- 20230801
LR  - 20230801
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 20
IP  - 8
DP  - 2023 Aug
TI  - Improved outcomes of conduction system pacing in heart failure with reduced 
      ejection fraction: A systematic review and meta-analysis.
PG  - 1178-1187
LID - S1547-5271(23)02226-9 [pii]
LID - 10.1016/j.hrthm.2023.05.010 [doi]
AB  - Conduction system pacing (CSP)-His bundle pacing (HBP) and left bundle branch 
      area pacing (LBBAP)-are emerging alternatives to biventricular pacing (BVP) for 
      cardiac resynchronization therapy (CRT) in heart failure. However, evidence is 
      largely limited to small and observational studies. We conducted a meta-analysis 
      including a total of 15 randomized controlled trials (RCTs) and non-RCTs that 
      compare CSP (HBP and LBBAP) with BVP in patients with CRT indications. We 
      assessed the mean differences in QRS duration (QRSd), pacing threshold, left 
      ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class 
      score. CSP resulted in a pooled mean QRSd improvement of -20.3 ms (95% confidence 
      interval [CI] -26.1 to -14.5 ms; P < .05; I(2)= 87.1%) vs BVP. For LVEF, a 
      weighted mean increase of 5.2% (95% CI 3.5%-6.9%; P < .05; I(2) = 55.6) was 
      observed after CSP vs BVP. The mean NYHA score was reduced by -0.40 (95% CI -0.6 
      to -0.2; P < .05; I(2) = 61.7) after CSP vs BVP. A subgroup analysis of outcomes 
      stratified by LBBAP and HBP demonstrated statistically significant weighted mean 
      improvements of QRSd and LVEF with both CSP modalities compared with BVP. LBBAP 
      resulted in NYHA improvement compared with BVP, without differences between CSP 
      subgroups. LBBAP is associated with a significantly lowered mean pacing threshold 
      of -0.51 V (95% CI -0.68 to -0.38 V) while HBP had increased the mean threshold 
      (0.62 V; 95% CI -0.03 to 1.26 V) compared with BVP; however, this was associated 
      with significant heterogeneity. Overall, both CSP techniques are feasible and 
      effective CRT alternatives for heart failure. Further RCTs are needed to 
      establish long-term efficacy and safety.
CI  - Copyright (c) 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights 
      reserved.
FAU - Gin, Julian
AU  - Gin J
AD  - Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
FAU - Chow, Chee Loong
AU  - Chow CL
AD  - Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; 
      Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia.
FAU - Voskoboinik, Alex
AU  - Voskoboinik A
AD  - Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
FAU - Nalliah, Chrishan
AU  - Nalliah C
AD  - Department of Cardiology, Macquarie University Hospital, Sydney, New South Wales, 
      Australia.
FAU - Wong, Chiew
AU  - Wong C
AD  - Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia.
FAU - Van Gaal, William
AU  - Van Gaal W
AD  - Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia.
FAU - Farouque, Omar
AU  - Farouque O
AD  - Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia.
FAU - Mohamed, Uwais
AU  - Mohamed U
AD  - Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia; Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, 
      Victoria, Australia.
FAU - Lim, Han S
AU  - Lim HS
AD  - Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; 
      Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia.
FAU - Kalman, Jonathan M
AU  - Kalman JM
AD  - Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia; Department of Cardiac Electrophysiology, Royal Melbourne Hospital, 
      Melbourne, Victoria, Australia.
FAU - Wong, Geoffrey R
AU  - Wong GR
AD  - Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; 
      Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; 
      Department of Medicine, The University of Melbourne, Melbourne, Victoria, 
      Australia. Electronic address: geoffrey.r.wong@nh.org.au.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20230510
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Humans
MH  - Bundle of His
MH  - Electrocardiography/methods
MH  - Treatment Outcome
MH  - Heart Conduction System
MH  - Cardiac Conduction System Disease
MH  - *Cardiac Resynchronization Therapy/methods
MH  - Ventricular Function, Left
MH  - Stroke Volume
MH  - *Heart Failure/therapy
OTO - NOTNLM
OT  - Biventricular pacing
OT  - Cardiac resynchronization therapy
OT  - Conduction system pacing
OT  - Heart failure
OT  - His bundle pacing
OT  - Left bundle branch pacing
EDAT- 2023/05/13 15:12
MHDA- 2023/08/01 06:45
CRDT- 2023/05/12 19:24
PHST- 2023/03/06 00:00 [received]
PHST- 2023/04/25 00:00 [revised]
PHST- 2023/05/04 00:00 [accepted]
PHST- 2023/08/01 06:45 [medline]
PHST- 2023/05/13 15:12 [pubmed]
PHST- 2023/05/12 19:24 [entrez]
AID - S1547-5271(23)02226-9 [pii]
AID - 10.1016/j.hrthm.2023.05.010 [doi]
PST - ppublish
SO  - Heart Rhythm. 2023 Aug;20(8):1178-1187. doi: 10.1016/j.hrthm.2023.05.010. Epub 
      2023 May 10.