Clinical and electrophysiological outcomes of left bundle area pacing compared to bi-ventricular pacing: an updated meta-analysis

The Left bundle branch area pacing (LBBAP) is a novel pacing strategy that utilizes the conduction system distal to the left bundle branch block level for direct activation of the left bundle and the right ventricular myocardium. Our meta-analysis compared the structural, electrophysiological, clinical, and procedural outcomes of LBBAP and Bi-ventricular pacing (BVP). The meta-analysis included two randomized control trials and showed significant reductions in left ventricular systolic and diastolic volumes with LBBAP compared to BVP, along with a statistically significant decrease in QRS duration, NYHA class, and heart failure hospitalizations. Fluoroscopic time was also significantly shorter in the LBBAP group. However, no significant change in LV ejection fraction was noted. Although not statistically significant, procedural complications were slightly higher in the LBBAP group. Our findings suggest that LBBAP may be a superior alternative to standard BVP in improving structural and electrophysiological components and clinical components of cardiomyopathy, including NYHA class and heart failure hospitalizations. LBBAP is a more physiological pacing strategy that results in normal ventricular activation and may be a viable alternative to BVP for cardiac synchronization therapy.