His-Purkinje system pacing versus biventricular pacing in clinical efficacy: a systematic review and meta-analysis

Wang，Ya1; Liu，Fangchao1; Liu，Mengyao1; Wang，Zefeng2; Lu，Xiangfeng1; Huang，Jianfeng1; Gu，Dongfeng1,3

2023-12-01

10.1186/s12872-023-03307-7

BMC Cardiovascular Disorders   Impact Factor & Quartile

1471-2261

1471-2261

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 = 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 = 0%), decreased left ventricular end-diastolic dimension (LVEDD) (MD: -2.91, 95% CI: -4.86 to -0.95, P = 0.004, I = 35%), and more improved NYHA functional classification (MD: -0.45, 95% CI: -0.67 to -0.23, P < 0.001, I = 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 = 0%], clinical (OR: 2.10, 95% CI: 1.16 to 3.80, P = 0.01, I = 0%) and super clinical (OR: 3.17, 95% CI: 2.09 to 4.79, P < 0.001, I = 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 = 0%), while presented no difference (OR: 0.68, 95% CI: 0.44 to 1.06, P = 0.09, I = 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 = 57%), but had no difference with HBP (MD: 0.11 V, 95% CI: -0.09 to 0.31, P = 0.28, I = 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. Graphical Abstract: [Figure not available: see fulltext.]

Biventricular pacing Cardiac resynchronization therapy His-purkinje system pacing Meta-analysis

SCI

English

Corresponding

National Natural Science Foundation of China[12126602];

Cardiovascular System & Cardiology

Cardiac & Cardiovascular Systems

WOS:001000610600003

BMC

2-s2.0-85160884407

Scopus

1.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,Beijing,No. 167 Beilishi Road,100037,China
2.Department of Cardiology,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing,China
3.School of Medicine,Southern University of Science and Technology,Shenzhen,518055,China

Wang，Ya,Liu，Fangchao,Liu，Mengyao,et al. His-Purkinje system pacing versus biventricular pacing in clinical efficacy: a systematic review and meta-analysis[J]. BMC Cardiovascular Disorders,2023,23(1).

Wang，Ya.,Liu，Fangchao.,Liu，Mengyao.,Wang，Zefeng.,Lu，Xiangfeng.,...&Gu，Dongfeng.(2023).His-Purkinje system pacing versus biventricular pacing in clinical efficacy: a systematic review and meta-analysis.BMC Cardiovascular Disorders,23(1).

Wang，Ya,et al."His-Purkinje system pacing versus biventricular pacing in clinical efficacy: a systematic review and meta-analysis".BMC Cardiovascular Disorders 23.1(2023).