Introduction
Cardiac resynchronization therapy (CRT) is the first-line treatment for
patients with systolic dysfunction heart failure (HF) and ventricular
asynchrony [1]. Biventricular pacing (BVP) substantially
improves functional capacity and quality of life and reduces morbidity
and mortality among patients with heart failure with reduced ejection
fraction (HFrEF) with left bundle branch block (LBBB) > 150
msec. However, BVP is hindered by cardiac venous anatomy and difficulty
in LV lead positioning, and thus, up to 30% of patients are CRT
non-responders [1-3] . Several studies have shown that left
bundle branch area pacing (LBBAP), which is reverse LV remodeling in
patients with HFrEF indicated for CRT, is practical in patients with HF
and bradycardia [4,5] . LBBAP can lead to a relatively
narrow QRS duration (QRSd) and rapid left ventricular activation with
direct excitation distal to the LBBB site, thus improving clinical and
echocardiographic findings [6].
Thus, the benefits of LBBAP, such as improvement in clinical and
echocardiographic findings and fewer complications, have gained interest
as a potential alternative to BVP [7-21] . However, the data
to support these notions remain controversial. Accordingly, this
systematic review and meta-analysis aimed to determine the benefits in
patients with HFrEF who underwent LBBAP implantation.