His-bundle Pacing For Cardiac Resynchronization Therapy:A Systematic Literature Review And Meta-analysis

Aims Permanent His bundle pacing has been to shown to be an alternative for the patients with CRT indications and more recently has been evaluated for feasibility as a first-line strategy.Data on HBP for cardiac resynchronization therapy are largely limited to small single-centre reports,and clinical benefits and risks have not been systematically examined.The purpose of this study was to systematically review published studies of HBP for cardiac resynchronization therapy and evaluate the feasibility and efficacy of the therapy.Methods PubMed,Cochrane Library,Embase,CNKI and WANFANG databases were searched up to December 2019 to identify relevant studies.Clinical outcomes of interest include implant success rate,QRS duration,pacing thresholds,LVEF,LVEDD,NYHA status,complications,and mortality.Extract and summarize the data.Using Revman5.3 software to perform the Meta-analysis Results Atotal of 13 studies involving 503 patients were included.The average implant success rate was 79.8%(95%CI 72.4%-87.2%).Permanent HBP resulted in a significant narrow of mean QRS duration from 165.5 ± 8.7ms to 122.9±12.0ms(MD=43.5,95%CI:36.34～50.56,p<0.001).Atrend of increase was observed in capture thresholds at follow-up compared to the baseline threshold(MD=-0.24,95%Cl:-0.38～-0.10,p=0.001).Average NYHAfunctional class(MD=1.2,95%CI:1.09～1.31,p<0.001),LVEF(MD=-12.60,95%CI:-14.32～-10.87,p<0.001),LVEDD(MD=4.30,95%Cl:3.05～5.55,p<0.001)significantly improved at>3 months follow-up compared to the baseline(p<0.001).Ten studies reported safety information and the most commonly reported complication was the increase in HB capture threshold.Conclusion HBP is feasible with high success rates in patients requiring CRT.HBP could achieve significant narrow of QRS duration and improves left ventricular function during follow-up.Randomized controlled trials are needed to further assess the efficacy of HBP compared to BVP in achieving CRT.