A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing

• 出版年: Biomedicines
• 主要な著者: Patrycja Paluszkiewicz, Adrian Martuszewski, Jacek Smereka, Jacek Gajek
• フォーマット: 論文
• 言語: 英語
• 出版事項: MDPI AG 2025-05-01
• 主題: His bundle pacing; left bundle branch area pacing; left bundle branch pacing; heart failure; biventricular pacing; right ventricular pacing
• オンライン･アクセス: https://www.mdpi.com/2227-9059/13/6/1359

<b>Background</b>: Conduction system pacing (CSP), encompassing His bundle <i>pacing</i> (HBP) and left bundle branch area pacing (LBBAP), has emerged as an alternative to conventional pacing methods such as right ventricular pacing (RVP) and biventricular pacing (BVP). This meta-analysis aimed to compare the effects of CSP versus conventional pacing on left ventricular function and selected clinical and electrophysiological outcomes. <b>Methods</b>: Prospective and retrospective studies (randomized, observational, registry-based) reporting pre-post data or direct comparisons between CSP (HBP, LBBAP) and conventional methods (BVP, RVP) for at least one of LVEF, LVESV, LVEDV, QRS duration, NYHA class, NT-proBNP, R-wave, or pacing threshold were included. PubMed and Web of Science databases were searched up to 31 March 2025. Quality assessment (QualSyst), publication bias (Egger’s test, trim-and-fill), subgroup analyses, and meta-regression (follow-up duration) were performed. The review was registered in the INPLASY database (INPLASY202540050). <b>Results</b>: 28 studies (8777 patients, 47 comparisons) were included. CSP significantly improved LVEF (<i>SMD</i> = 1.16; 95%CI: 0.94–1.38), shortened QRS duration (SMD = 0.75; 95%CI: 0.24–1.26), and reduced NYHA class (SMD = 1.94; 95%CI: 1.59–2.29), NT-proBNP levels (SMD = 1.27; 95%CI:0.85–1.69), LVEDV (SMD = 0.90; 95%CI: 0.42–1.38), and LVESV (SMD = 1.31; 95%CI: 0.81–1.81). In head-to-head comparisons, LBBAP and HBP showed similar efficacy, both superior to conventional pacing. Improvement in LVEF significantly correlated with longer follow-up (<i>p</i> = 0.004). Publication bias was non-significant (Egger <i>p</i> = 0.15), despite high heterogeneity (I² > 90%). <b>Conclusions</b>: CSP demonstrated superior clinical and echocardiographic outcomes compared to conventional pacing. Limitations include the predominance of non-randomized studies, high heterogeneity, and variability in follow-up duration, supporting the need for high-quality randomized trials.