Abstract 14047: Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Patients With Left Ventricular Systolic Failure: A Systematic Review and Meta-Analysis

Abstract

Introduction: There is limited data comparing the effectiveness of Left Bundle Branch Area Pacing (LBBAP) and traditional Biventricular Pacing (BiVP) in patients with left ventricular systolic failure. The aim of this study was to assess the electromechanical and clinical outcomes of both cardiac resynchronization (CRT) techniques. Hypothesis: LBBAP offers comparable or superior clinical outcomes compared to BiVP in patients with systolic left ventricular failure Methods: We conducted a systematic review of PubMed (MEDLINE), Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) for studies comparing LBBAP with BiVP from inception till May 22, 2023. To evaluate categorical and continuous outcomes, risk ratios (RRs) and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated using RevMan version 5.4 software. Results: We selected 12 studies involving 3,004 patients (LBBP=1,242; BiVP=1,762) for our meta-analysis. The pooled results demonstrated significant improvements with LBBAP in left ventricular ejection fraction (LVEF) (SMD=0.40, 95%CI[0.25, 0.54], P<0.00001), NYHA functional class (SMD=-0.44, 95%CI[-0.65, -0.23], P<0.0001), reduction in QRS duration (SMD=-0.90, 95%CI[-1.14, -0.66], P<0.00001), fewer heart failure hospitalizations (RR=0.72, 95%CI [0.62, 0.85], P<0.0001), and improved survival (RR=0.73, 95%CI [0.58, 0.92], P=0.007). Additionally, LBBAP was associated with a lower pacing threshold at implantation (SMD=-1.03, 95%CI[-1.32, -0.74], P<0.00001) as compared to BiVP. Conclusions: LBBAP was associated with significant improvements in both electromechanical and clinical outcomes, including LVEF, reduction in QRS duration, NYHA class, heart failure hospitalizations, and all-cause mortality in patients with systolic left ventricular failure.