Meta-Analysis Comparing Safety and Efficacy of Left Bundle Branch Area Pacing Versus His Bundle Pacing

Although His bundle pacing (HBP) can provide a physiologic ventricular activation pattern, it has disadvantages such as the difficulty of lead implantation, reduced R wave amplitudes, and high and unstable pacing thresholds. Recent studies have demonstrated that left bundle branch area pacing (LBBaP) might overcome these deficiencies. A total of 7 nonrandomized controlled studies including 786 patients (n = 442 receiving LBBaP and n = 344 receiving HBP) with bradyarrhythmia were evaluated. Compared with HBP, LBBaP appeared to result in increased R wave amplitudes (at implant: MD 9.84 mV, 95% confidence interval [CI] 7.61 to 12.06 mV; at follow-up: MD 7.62 mV, 95% CI 6.73 to 8.50 mV), lowered capture thresholds (at implant: MD -0.73 V, 95% CI -0.81 to -0.64 V; at follow-up: MD -0.71 V, 95% CI -0.92 to -0.50 V), shortened procedure times (MD -16.70 minutes, 95% CI -26.51 to -6.90 minutes) and fluoroscopic durations (MD -6.16 min, 95% CI -8.28 to -4.03 minutes), and increased success rates (odds ratio 2.14, 95% CI 1.23 to 3.74); all of these differences were significant. However, paced QRS durations, the lead impedance at implantation and follow-up, and incidence of lead-related complications such as lead dislodgement did not significantly differ between LBBaP and HBP. In conclusion, current evidence suggests that LBBaP is a potential alternative to HBP as a pacing modality with which to maintain an ideal physiologic pattern of ventricular activation through native His-Purkinje system stimulation.