Left Bundle Branch Area Pacing vs. Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis

Background: Left bundle branch area pacing (LBBAP) is a recently proposed method for conduction system pacing. We performed a meta-analysis of controlled studies to compare the clinical outcome in patients who received LBBAP vs. biventricular pacing (BVP) for cardiac resynchronization therapy (CRT). Methods: PubMed, Embase, and Cochrane's Library databases were searched for relevant controlled studies. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results: Four non-randomized controlled studies including 249 patients with heart failure (HF) for CRT were included, and the patients were followed for 6-12 months. Compared with BVP, LBBAP was associated with significantly shortened QRS duration [mean difference (MD): -29.18 ms, 95% confidence interval (CI): -33.55-24.80, I-2 = 0%, P < 0.001], improved left ventricular ejection fraction (MD: 6.93%, 95% CI: 4.69-9.17, I-2 = 0%, P < 0.001), reduced left ventricular end-diastolic dimension (MD: -2.96 mm, 95% CI: -5.48 to -0.44, I-2 = 0%, P = 0.02), and improved New York Heart Association class (MD: -0.54, 95% CI: -0.84 to -0.24, I-2 = 65%, P < 0.001). Moreover, patients who received LBBAP were more likely to achieve echocardiographic [odds ratio (OR): 5.04, 95% CI: 2.17-11.69, I-2 = 0%, P < 0.001] and clinical (OR: 7.33, 95% CI: 1.62-33.16, I-2 = 0%, P = 0.01) CRT responses. Conclusion: Current evidence from non-randomized studies suggests that LBBAP appears to be a promising method for CRT, which is associated with more remarkable improvements of symptoms and cardiac function in HF patients with indication for CRT.