Po-05-055 a meta-analytic comparison of outcomes of left bundle branch area pacing (lbbp) versus bi-ventricular pacing for cardiac resynchronization therapy

Left bundle branch area pacing (LBBP), has emerged as a novel method to deliver cardiac resynchronization therapy (CRT), as an alternative to biventricular pacing (BVP). We aimed to evaluate the outcomes of LBBP as an alternative to BVP as a method of CRT. We aimed to evaluate the outcomes of LBBP as an alternative to BVP as a method of CRT. A systematic literature-based search was performed on various electronic databases, i.e., PubMed, Embase, Scopus, and Cochrane libraries, for studies that compared LBBP with BVP. The primary outcomes that were studied were changes in left ventricular end-diastolic diameter (LVEDD), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF) and paced QRS duration post CRT device implantation. Six articles (1 randomized trial and five observational studies) with a total of 399 patients (42% with LBBP as CRT) were included in the final analysis. A pooled random-effects analysis of the primary outcomes revealed that patients who underwent LBBP had a significantly greater reduction in left ventricular end-diastolic diameter [Mean Difference (MD) 0.40 (95% Confidence Interval (CI), 0.17-0.63); p < 0.001] and paced QRS duration [MD 1.03 (95% CI, 0.63-1.43); p < 0.001] as compared to the BVP group. There was also a significantly greater improvement in NYHA class [MD 0.64 (95% CI, 0.33-0.96); p < 0.001] and the LVEF [MD 0.83 (95% CI, 0.33-1.33); p < 0.001] in the LBBP group. (Figure 1 with the forest plots) LBBP has the potential to improve clinical outcomes over conventional BVP in patients undergoing CRT. This finding should be further confirmed by randomized trials with a larger sample size and well-defined outcome measures and feasibility indicators. Although limited by the observational nature of the included studies, our meta-analysis sets the stage towards the consideration of LBBP in patients who meet the indications for CRT.