Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

BACKGROUND Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP). METHODS Published studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis. RESULTS HBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% - 6.1%), lower NYHA class (WMD = -0.5, 95% CI: -0.7 - -0.3), WMD of LVESV = -0.1 ml, 95% CI: -3.0 - 2.8 ml), less inter-ventricular asynchrony (WMD = -13.2 ms, 95% CI: -16.4 - -10.0 ms), and shorter QRS duration for long-term (WMD = -36.9 ms, 95% CI: -40.0 - -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = -2.4 ml, 95% CI: -5.0 - 0.2 ml; WMDLVESV = -0.1 ml, 95% CI: -3.0 - 2.8 ml) compared to RVP. CONCLUSIONS The efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume.