Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(7), 713–720. https://doi.org/10.1002/clc.24028 Dr. Ga-In Yu et al.
Points
- Left bundle branch area pacing (LBBAP) is investigated as an alternative to cardiac resynchronization therapy (CRT) for heart failure patients with mildly reduced ejection fraction (HFmrEF), focusing on LVEF between 35% and 50%.
- A systematic review and meta-analysis involved eight studies and 211 HFmrEF patients who underwent LBBAP across 16 centers. The success rate of LBBAP implantation was 91.3% using lumenless pacing leads.
- The study observed significant improvements in cardiac function during an average follow-up of 9.1 months. LVEF increased from an average of 39.8% at baseline to 50.5% at follow-up, with a mean difference of 10.90% (95% CI: 6.56−15.23, p < .01).
- QRS duration, a measure of electrical conduction in the heart, decreased significantly from an average of 152.6 ms at baseline to 119.3 ms at follow-up, with a mean difference of −34.51 ms (95% CI: −60.00 to −9.02, p < .01).
- The findings support the potential use of LBBAP as a viable alternative to CRT strategies, demonstrating its capacity to improve QRS duration and enhance systolic function in HFmrEF patients with specific LVEF ranges.
Summary
This research paper presents a systematic review and meta-analysis investigating the efficacy of left bundle branch area pacing (LBBAP) as an alternative strategy to cardiac resynchronization therapy (CRT) for patients with heart failure and mildly reduced ejection fraction (HFmrEF). The study focused on patients with a left ventricular ejection fraction (LVEF) ranging from 35% to 50%. A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to identify relevant articles published up to July 17, 2022. The primary outcomes of interest included changes in QRS duration and LVEF at baseline and follow-up in patients with mid-range heart failure.
Out of 1065 initially screened articles, eight studies met the inclusion criteria, involving 211 HFmrEF patients who underwent LBBAP across 16 centers. The findings revealed a notable success rate of 91.3% for LBBAP implantation when using lumenless pacing leads. Additionally, the study reported 19 complications among the enrolled patients during the follow-up period, with an average duration of 9.1 months. Notably, the results demonstrated a significant improvement in cardiac function, as evidenced by an increase in LVEF from an average of 39.8% at baseline to 50.5% at follow-up. This improvement represented a mean difference of 10.90% (95% CI: 6.56−15.23, p < .01). Furthermore, QRS duration was significantly reduced from an average of 152.6 ms at baseline to 119.3 ms at follow-up, with a mean difference of −34.51 ms (95% CI: −60.00 to −9.02, p < .01).
In conclusion, the study’s findings suggest that LBBAP can effectively reduce QRS duration and enhance systolic function in HFmrEF patients with LVEF values between 35% and 50%. These results support the potential application of LBBAP as a viable alternative to traditional CRT strategies for managing HFmrEF, highlighting its promise as an innovative approach in cardiac pacing therapy.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24028
References Yu, G., Kim, T., Cho, Y., Bae, J., Ahn, J., Jang, J. Y., Park, Y. W., & Kwak, C. H. (2023). Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta‐analysis. Clinical Cardiology, 46(7), 713–720. https://doi.org/10.1002/clc.24028
