Table 4_Left bundle branch area pacing vs. biventricular pacing significantly improves clinical outcomes and cardiac remodeling in cardiac resynchronization therapy: a systematic review and meta-analysis.docx

BackgroundBiventricular pacing (BiVP) is the conventional approach for cardiac resynchronization therapy (CRT), yet approximately one-third of patients show no clinical response. Left bundle branch area pacing (LBBAP) enables more physiological ventricular activation through His-Purkinje conduction, but its impact on key clinical endpoints such as all-cause mortality and heart failure hospitalization (HFH) remains debated.
MethodsA systematic search of PubMed, Embase, Cochrane Library, and CNKI (to May 3, 2025) identified 24 studies encompassing 6,538 patients. Study quality was assessed using Cochrane RoB 2.0 and the Newcastle–Ottawa Scale. Subgroup analyses (by follow-up duration, study design, and sex), leave-one-out sensitivity analysis, and meta-regression were performed to assess result robustness and heterogeneity sources. Trim-and-fill correction was applied to adjust for potential publication bias.
ResultsLBBAP was associated with a markedly lower risk compared to BiVP across several clinical outcomes. Specifically, it significantly reduced the risk of the composite endpoint (HR: 0.67, 95% CI: 0.59–0.75), all-cause mortality (HR: 0.83, 95% CI: 0.71–0.96), and HFH (HR: 0.58, 95% CI: 0.50–0.67). Echocardiographic outcomes further supported LBBAP superiority, with higher rates of echocardiographic response (OR: 1.57, 95% CI: 1.36–1.81) and super-response (OR: 2.12, 95% CI: 1.62–2.76). Improvements in left ventricular ejection fraction (LVEF) were greater with LBBAP at both 3–6 months (MD: 5.31%, 95% CI: 4.63–5.99) and ≥12 months (MD: 4.43%, 95% CI: 2.27–6.60). Similarly, left ventricular end-diastolic diameter (LVEDD) reductions were more pronounced at 3–6 months (MD: −3.48 mm, 95% CI: −5.76 to −1.21) and ≥12 months (MD: −2.86 mm, 95% CI: −5.05 to −0.68).
ConclusionsThese findings indicate that LBBAP provides superior clinical and structural outcomes compared to BiVP in patients undergoing CRT. Large-scale, multicenter randomized controlled trials are warranted to confirm these results, assess long-term efficacy, and elucidate gender-specific variations to optimize evidence-based CRT delivery.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251055488, PROSPERO CRD420251055488.