Please use this identifier to cite or link to this item:
http://dx.doi.org/10.25673/112136
Title: | Effectiveness of conduction system pacing for cardiac resynchronization therapy : a systematic review and network meta-analysis |
Author(s): | Tavolinejad, Hamed Bozorgi, Ali Kazemian, Sina Michalski, Roman Hoyer, Daniel Sedding, Daniel ![]() Arya, Arash ![]() |
Issue Date: | 2023 |
Type: | Article |
Language: | English |
Abstract: | Introduction: Cardiac resynchronization therapy (CRT) with biventricular pacing (BiV-CRT) is ineffective in approximately one-third of patients. CRT with Conduction system pacing (CSP-CRT) may achieve greater synchronization. We aimed to assess the effectiveness of CRT with His pacing (His-CRT) or left bundle branch pacing (LBB-CRT) in lieu of biventricular CRT. Methods and Results: The PubMed, Embase, Web of Science, Scopus, and the Cochrane Library were systematically searched until August 19, 2023, for original studies including patients with reduced left ventricular ejection fraction (LVEF) who received His- or LBB-CRT, that reported either CSP-CRT success, LVEF, QRS duration (QRSd), or New York Heart Association (NYHA) classification. Effect measures were compared with frequentist network meta-analysis. Thirty-seven publications, including 20 comparative studies, were included. Success rates were 73.5% (95% CI: 61.2–83.0) for His-CRT and 91.5% (95% CI: 88.0–94.1) for LBB-CRT. Compared to BiV-CRT, greater improvements were observed for LVEF (mean difference [MD] for His-CRT +3.4%; 95% CI [1.0; 5.7], and LBB-CRT: +4.4%; [2.5; 6.2]), LV end-systolic volume (His-CRT:17.2mL [29.7; 4.8]; LBB-CRT:15.3mL [28.3; 2.2]), QRSd (His-CRT: –17.1ms [–25.0; –9.2]; LBB-CRT: –17.4ms [–23.2; –11.6]), and NYHA (Standardized MD [SMD]: His-CRT:0.4 [0.8; 0.1]; LBB-CRT:0.4 [–0.7; –0.2]). Pacing thresholds at baseline and follow-up were significantly lower with LBB-CRT versus both His-CRT and BiV-CRT. CSP-CRT was associated with reduced mortality (R = 0.75 [0.61–0.91]) and hospitalizations risk (RR = 0.63 [0.42–0.96]). Conclusion: This study found that CSP-CRT is associated with greater improvements in QRSd, echocardiographic, and clinical response. LBB-CRT was associated with lower pacing thresholds. Future randomized trials are needed to determine CSP-CRT efficacy. |
URI: | https://opendata.uni-halle.de//handle/1981185920/114094 http://dx.doi.org/10.25673/112136 |
Open Access: | ![]() |
License: | ![]() |
Journal Title: | Journal of cardiovascular electrophysiology |
Publisher: | Wiley-Blackwell |
Publisher Place: | Oxford |
Volume: | 34 |
Issue: | 11 |
Original Publication: | 10.1111/jce.16086 |
Page Start: | 2342 |
Page End: | 2359 |
Appears in Collections: | Open Access Publikationen der MLU |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
Cardiovasc electrophysiol - 2023 - Tavolinejad - Effectiveness of conduction system pacing for cardiac resynchronization.pdf | 1.77 MB | Adobe PDF | ![]() View/Open |