Meta-analysis of clinical outcomes in cardiac resynchronisation therapy: his bundle pacing vs biventricular pacing

ABSTRACT

Introduction and objective

Cardiac resynchronization may treat severe heart failure (HF) with pharmacological optimization, left branch block, and an ejection fraction<35%. However, 30–40% of patients fail therapy. HBP could replace biventricular pacing (BiV). We compared the effectiveness of HBP versus BiV in HF patients.

Methods

We searched PubMed, Embase, and Cochrane for studies on QRS, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, left ventricular end-systolic volume (LVESV), and 6-minute walk test.

Results

Six publications included 774 patients (mean [± standard deviation] age: 66.9 [14.0] years; 484 (62.5%) were males; 408 [52.71%] underwent HBP; the mean follow-up was 6–12 months. The HBP group had a higher QRS reduction in the meta-analysis (median: −17.54 [−20.46, −14.62]; I² = 89%). LVEF showed a median of 8.48 (7.55, 9.41) and I² of 98%, with a higher mean in HBP. The LVESV median was −18.89 (−30.03, −7.75) and I² was 0%, and the HBP group had a lower mean. HBP had a lower NYHA functional class (median= −0.20 [−0.28, −0.12]).

Conclusion

After implantation, HBP demonstrated bigger QRS shortening, increased LVEF, lower LVES volume, and lower NYHA class than BiV pacing.

KEYWORDS:

• Biventricular pacing
• cardiac resynchronization therapy
• heart failure
• his bundle pacing
• Hisian pacing
• meta-analysis

Article Highlights

• HBP showed to be more effective and secure than BiV pacing

• HBP is a possible alternative in cardiac resynchronization therapy

• Physiological stimulation should reduce nonresponders.

• LVEF improvement with HBP was superior to that under BiV pacing.

Authors’ contribution

Menezes Jr AS work conception, database organization, statistical analysis, data interpretation, manuscript writing, and critical review. Melo MGZ analysis of the results, manuscript writing, and critical review. Barreto LP participated in manuscript writing, data interpretation, and critical review.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2023.2202816.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.