Effectiveness of conduction system pacing for cardiac resynchronization therapy: A systematic review and network meta-analysis.


Journal

Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756

Informations de publication

Date de publication:
Nov 2023
Historique:
revised: 31 08 2023
received: 22 05 2023
accepted: 17 09 2023
medline: 20 11 2023
pubmed: 28 9 2023
entrez: 28 9 2023
Statut: ppublish

Résumé

Cardiac resynchronization therapy (CRT) with biventricular pacing (BiV-CRT) is ineffective in approximately one-third of patients. CRT with Conduction system pacing (CSP-CRT) may achieve greater synchronization. We aimed to assess the effectiveness of CRT with His pacing (His-CRT) or left bundle branch pacing (LBB-CRT) in lieu of biventricular CRT. The PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were systematically searched until August 19, 2023, for original studies including patients with reduced left ventricular ejection fraction (LVEF) who received His- or LBB-CRT, that reported either CSP-CRT success, LVEF, QRS duration (QRSd), or New York Heart Association (NYHA) classification. Effect measures were compared with frequentist network meta-analysis. Thirty-seven publications, including 20 comparative studies, were included. Success rates were 73.5% (95% CI: 61.2-83.0) for His-CRT and 91.5% (95% CI: 88.0-94.1) for LBB-CRT. Compared to BiV-CRT, greater improvements were observed for LVEF (mean difference [MD] for His-CRT +3.4%; 95% CI [1.0; 5.7], and LBB-CRT: +4.4%; [2.5; 6.2]), LV end-systolic volume (His-CRT:17.2mL [29.7; 4.8]; LBB-CRT:15.3mL [28.3; 2.2]), QRSd (His-CRT: -17.1ms [-25.0; -9.2]; LBB-CRT: -17.4ms [-23.2; -11.6]), and NYHA (Standardized MD [SMD]: His-CRT:0.4 [0.8; 0.1]; LBB-CRT:0.4 [-0.7; -0.2]). Pacing thresholds at baseline and follow-up were significantly lower with LBB-CRT versus both His-CRT and BiV-CRT. CSP-CRT was associated with reduced mortality (R = 0.75 [0.61-0.91]) and hospitalizations risk (RR = 0.63 [0.42-0.96]). This study found that CSP-CRT is associated with greater improvements in QRSd, echocardiographic, and clinical response. LBB-CRT was associated with lower pacing thresholds. Future randomized trials are needed to determine CSP-CRT efficacy.

Identifiants

pubmed: 37767743
doi: 10.1111/jce.16086
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2342-2359

Informations de copyright

© 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.

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Auteurs

Hamed Tavolinejad (H)

Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Sina Kazemian (S)

Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Ali Bozorgi (A)

Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Roman Michalski (R)

Clinic and Polyclinic for Cardiology, Angiology and Intensive Care, University Hospital Halle, Martin-Luther University, Halle (Saale), Germany.

Daniel Hoyer (D)

Clinic and Polyclinic for Cardiology, Angiology and Intensive Care, University Hospital Halle, Martin-Luther University, Halle (Saale), Germany.

Daniel Sedding (D)

Clinic and Polyclinic for Cardiology, Angiology and Intensive Care, University Hospital Halle, Martin-Luther University, Halle (Saale), Germany.

Arash Arya (A)

Clinic and Polyclinic for Cardiology, Angiology and Intensive Care, University Hospital Halle, Martin-Luther University, Halle (Saale), Germany.

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