A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing
<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...
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2025-05-01
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| author | Patrycja Paluszkiewicz Adrian Martuszewski Jacek Smereka Jacek Gajek |
| author_facet | Patrycja Paluszkiewicz Adrian Martuszewski Jacek Smereka Jacek Gajek |
| author_sort | Patrycja Paluszkiewicz |
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| description | <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 (I<sup>2</sup> > 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. |
| format | Article |
| id | doaj-art-e53b7078f7bc49348ebe9204fe2eb7e1 |
| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-e53b7078f7bc49348ebe9204fe2eb7e12025-08-20T03:26:17ZengMDPI AGBiomedicines2227-90592025-05-01136135910.3390/biomedicines13061359A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional PacingPatrycja Paluszkiewicz0Adrian Martuszewski1Jacek Smereka2Jacek Gajek3Department of Emergency Medical Service, Wroclaw Medical University, ul. Parkowa 34, 51-616 Wrocław, PolandDivision of Environmental Health and Occupational Medicine, Department of Population Health, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wrocław, PolandDepartment of Emergency Medical Service, Wroclaw Medical University, ul. Parkowa 34, 51-616 Wrocław, PolandMedical Faculty, Wrocław University of Science and Technology, 50-368 Wrocław, Poland<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 (I<sup>2</sup> > 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.https://www.mdpi.com/2227-9059/13/6/1359His bundle pacingleft bundle branch area pacingleft bundle branch pacingheart failurebiventricular pacingright ventricular pacing |
| spellingShingle | Patrycja Paluszkiewicz Adrian Martuszewski Jacek Smereka Jacek Gajek A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing Biomedicines His bundle pacing left bundle branch area pacing left bundle branch pacing heart failure biventricular pacing right ventricular pacing |
| title | A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing |
| title_full | A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing |
| title_fullStr | A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing |
| title_full_unstemmed | A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing |
| title_short | A Meta-Analysis of Clinical and Echocardiographic Outcomes of Physiological Versus Conventional Pacing |
| title_sort | meta analysis of clinical and echocardiographic outcomes of physiological versus conventional pacing |
| topic | His bundle pacing left bundle branch area pacing left bundle branch pacing heart failure biventricular pacing right ventricular pacing |
| url | https://www.mdpi.com/2227-9059/13/6/1359 |
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