The electrocardiogram characteristics and pacing parameters of Permanent
left bundle branch area pacing : A systematic review and meta-analysis
Abstract
Background : The invention of His bundle pacing technology bring a new
revelation–Left bundle branch area pacing (LBBAP). LBBAP engages in the
electrical activation through left bundle branch area and produces
ventricular electrical synchronization, which can grab more cardiac
cells and increase the safety of pacing compared to His bundle pacing
(HBP). This pacing has been considered as an attractive mode to achieve
normal physiological pace markers. However,as a new technology, LBBAP is
still in the stage of clinical exploration and lacks adequate
evaluation. Objective :This study aims to investigate the
electrocardiogram characteristics,pacing parameters,the safety and the
effectiveness of LBBAP. Method : A computerized search of PubMed,
Embase, The CochraneLibrary, Chinese CNKI, CBM, Wanfang and Weipu
Chinese Sci-tech Journals database for effects of Left bundle pacing.
The baseline characteristics, the successful rate of implantation,
capture threshold, R-wave amplitude, pacing impedance, QRS duration and
follow-up date were extracted and summarized. Results : Thirteen studies
including 618 patients were included in this analysis. The overall
successful rate for implantation was 92.1%.Permanent LBBAP resulted in
narrow QRS duration when patients with QRS duration>120ms after
implantation (P=0.02). QRS duration and capture threshold of LBBAP
remained stable during follow-up. Moreover, there was a trend of
increased R-wave amplitude and declined pacing impedance at follow-up
compared to implantation (P=0.003 and P<0.00001, respectively).
Conclusion : Permanent LBBAP has shown promising results in
pacemaker-indicated patients. Good electrical synchronization, high
success rates, and stable pacemaker parameters point to the unparalleled
advantages of LBBAP in physiological pacing.