PMID- 37270513
OWN - NLM
STAT- MEDLINE
DCOM- 20230605
LR  - 20230614
IS  - 1471-2261 (Electronic)
IS  - 1471-2261 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Jun 3
TI  - His-Purkinje system pacing versus biventricular pacing in clinical efficacy: a 
      systematic review and meta-analysis.
PG  - 285
LID - 10.1186/s12872-023-03307-7 [doi]
LID - 285
AB  - BACKGROUND: His-Purkinje system pacing (HPSP), including his-bundle pacing (HBP) 
      and left bundle branch area pacing (LBBaP), imitates the natural conduction of 
      the heart as an alternative to biventricular pacing (BVP) in cardiac 
      resynchronization therapy (CRT). However, the feasibility and efficacy of HPSP 
      were currently only evidenced by studies with a limited sample size, so this 
      study aimed to provide a comprehensive assessment through a systematic review and 
      meta-analysis. METHODS: In order to compare the clinical outcomes associated with 
      HPSP and BVP in patients for CRT, PubMed, EMBASE, Cochrane Library and Web of 
      Science database were searched from inception to April 10, 2023. Clinical 
      outcomes of interest including QRS duration (QRSd), left ventricular (LV) 
      function and New York Heart Association (NYHA) functional classification, pacing 
      threshold, echocardiographic and clinical response, hospitalization rate of HF 
      and all-cause mortality were also extracted and summarized for meta-analysis. 
      RESULTS: A total of 13 studies (ten observational studies and three randomized 
      studies) involving 1,121 patients were finally included. The patients were 
      followed up for 6-27 months. Compared with BVP, CRT patients treated by HPSP 
      presented shorter QRSd [mean difference (MD): -26.23 ms, 95% confidence interval 
      (CI): -34.54 to -17.92, P < 0.001, I(2) = 91%], greater LV functional improvement 
      with increased left ventricular ejection fraction (LVEF) (MD: 6.01, 95% CI: 4.81 
      to 7.22, P < 0.001, I(2) = 0%), decreased left ventricular end-diastolic 
      dimension (LVEDD) (MD: -2.91, 95% CI: -4.86 to -0.95, P = 0.004, I(2) = 35%), and 
      more improved NYHA functional classification (MD: -0.45, 95% CI: -0.67 to -0.23, 
      P < 0.001, I(2) = 70%). In addition, HPSP was more likely to have higher 
      echocardiographic [odds ratio (OR): 2.76, 95% CI: 1.74 to 4.39, P < 0.001, 
      I(2) = 0%], clinical (OR: 2.10, 95% CI: 1.16 to 3.80, P = 0.01, I(2) = 0%) and 
      super clinical (OR: 3.17, 95% CI: 2.09 to 4.79, P < 0.001, I(2) = 0%) responses 
      than BVP, and a lower hospitalization rate of HF (OR: 0.34, 95% CI: 0.22 to 0.51, 
      P < 0.001, I(2) = 0%), while presented no difference (OR: 0.68, 95% CI: 0.44 to 
      1.06, P = 0.09, I(2) = 0%) in all-cause mortality compared with BVP. With 
      threshold change taking into account, BVP was less stable than LBBaP (MD: 
      -0.12 V, 95% CI: -0.22 to -0.03, P = 0.01, I(2) = 57%), but had no difference 
      with HBP (MD: 0.11 V, 95% CI: -0.09 to 0.31, P = 0.28, I(2) = 0%). CONCLUSION: 
      The present findings suggested that HPSP was associated with greater improvement 
      of cardiac function in patients with indication for CRT and was a potential 
      alternative to BVP to achieve physiological pacing through native his-purkinje 
      system.
CI  - (c) 2023. The Author(s).
FAU - Wang, Ya
AU  - Wang Y
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China.
FAU - Liu, Fangchao
AU  - Liu F
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China.
FAU - Liu, Mengyao
AU  - Liu M
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China.
FAU - Wang, Zefeng
AU  - Wang Z
AD  - Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical 
      University, Beijing, China.
FAU - Lu, Xiangfeng
AU  - Lu X
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China.
FAU - Huang, Jianfeng
AU  - Huang J
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China.
FAU - Gu, Dongfeng
AU  - Gu D
AUID- ORCID: 0000-0002-2781-7825
AD  - Department of Epidemiology, Fuwai Hospital, State Key Laboratory of 
      Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese 
      Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi 
      Road, Beijing, 100037, China. gudongfeng@cashq.ac.cn.
AD  - School of Medicine, Southern University of Science and Technology, Shenzhen, 
      518055, China. gudongfeng@cashq.ac.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20230603
PL  - England
TA  - BMC Cardiovasc Disord
JT  - BMC cardiovascular disorders
JID - 100968539
SB  - IM
MH  - Humans
MH  - *Cardiac Resynchronization Therapy/adverse effects
MH  - Stroke Volume
MH  - Ventricular Function, Left/physiology
MH  - Treatment Outcome
MH  - Heart Conduction System
MH  - Bundle of His
MH  - *Heart Failure/diagnosis/therapy/etiology
MH  - Electrocardiography/methods
MH  - Randomized Controlled Trials as Topic
PMC - PMC10239598
OTO - NOTNLM
OT  - Biventricular pacing
OT  - Cardiac resynchronization therapy
OT  - His-purkinje system pacing
OT  - Meta-analysis
COIS- The authors declare no competing interests.
EDAT- 2023/06/04 01:08
MHDA- 2023/06/05 06:42
PMCR- 2023/06/03
CRDT- 2023/06/03 23:15
PHST- 2022/10/30 00:00 [received]
PHST- 2023/05/16 00:00 [accepted]
PHST- 2023/06/05 06:42 [medline]
PHST- 2023/06/04 01:08 [pubmed]
PHST- 2023/06/03 23:15 [entrez]
PHST- 2023/06/03 00:00 [pmc-release]
AID - 10.1186/s12872-023-03307-7 [pii]
AID - 3307 [pii]
AID - 10.1186/s12872-023-03307-7 [doi]
PST - epublish
SO  - BMC Cardiovasc Disord. 2023 Jun 3;23(1):285. doi: 10.1186/s12872-023-03307-7.