Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block: A systematic review and meta-analysis

World J Cardiol. 2024 Jan 26;16(1):40-48. doi: 10.4330/wjc.v16.i1.40.


Background: Left bundle branch pacing (LBBP) is a novel pacing modality of cardiac resynchronization therapy (CRT) that achieves more physiologic native ventricular activation than biventricular pacing (BiVP).

Aim: To explore the validity of electromechanical resynchronization, clinical and echocardiographic response of LBBP-CRT.

Methods: Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.

Results: In our analysis, the success rate of LBBP-CRT was determined to be 91.1%. LBBP-CRT significantly shortened QRS duration, with significant improvement in echocardiographic parameters, including left ventricular ejection fraction, left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.

Conclusion: A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group. Lastly, the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Keywords: Biventricular pacing; Heart failure; Left bundle branch pacing; Left ventricular ejection fraction; QRS duration.