Network Meta-Analysis Of Optimal Selection Of Pacing Modalities In Patients With Heart Failure Requiring Pacing Therapy

Background: The prevalence of heart failure is still on the rise,and with the development of medical treatment,the treatment paradigm of heart failure has changed from pure drug therapy to active device therapy.In patients with heart failure requiring pacing therapy,from the early days of right ventricular pacing to cardiac resynchronization therapy based on biventricular pacing,and nowadays to the newer his bundle pacing and left bundle branch pacing,several studies have been conducted to compare the prognosis of different pacing modalities in heart failure patients.However,there is a lack of head-to-head studies directly comparing the four pacing modalities to determine the efficacy in terms of prognosis for patients with heart failure.This study used a reticulated Meta-analysis to evaluate the efficacy of the four pacing modalities in patients with heart failure to help guide clinicians in their selection.Methods: Computer searches of databases such as CNKI,Wanfang,Vip,Pub Med,The Cochrane Library,and Embase were conducted to collect clinical studies on right ventricular pacing,biventricular pacing,his bundle pacing and left bundle branch pacing applied to patients with heart failure,and the final included literature was identified according to the inclusion and exclusion criteria.Extracted outcome indicators including QRS duration,left ventricular ejection fraction(LVEF),pacing threshold,and heart failure rehospitalization(HFH)combined with the composite endpoint of death were analyzed by reticulated Meta-analysis using Stata 15.1 and ADDIS 1.16.5 and ranked for efficacy according to the area under the cumulative curve(SUCRA).Results: This study ultimately included 23 studies involving 2453 patients with heart failure with varying length of follow-up.Reticulated Meta-analysis showed that HBP was the most effective and RVP the least effective in shortening the duration of QRS,with SUCRA ranking results of HBP(98.8)> LBBP(67.8)> BVP(33.3)> RVP(0.0);In terms of improving LVEF,HBP and LBBP can be tied for first place in terms of efficacy,and RVP has the worst efficacy,with SUCRA ranking results of HBP(83.4)> LBBP(83.3)> BVP(33.3)> RVP(0.1);In terms of reducing the pacing threshold,LBBP ranked first in efficacy,HBP ranked fourth in efficacy,and the SUCRA ranking results were LBBP(88.1)> RVP(67.0)> BVP(33.5)> HBP(11.4);In terms of reducing the composite endpoint of HFH combined death,LBBP ranked first in efficacy,RVP ranked fourth in efficacy,and the SUCRA ranking results were LBBP(80.8)> HBP(68.1)> BVP(48.2)> RVP(2.9).Conclusion: HBP ranked first in the effect of shortening QRS duration,and the difference between LBBP and HBP was not significant.The efficacy of HBP and LBBP in improving LVEF was similar and not statistically different.LBBP significantly decreased the pacing threshold and had the greatest trend to reduce the composite endpoint of HFH combined with death.Therefore,LBBP appears to be a good option for patients with heart failure requiring pacing therapy and needs to be confirmed by randomized controlled studies with larger sample sizes and longer,higher quality follow-up.