His-Purkinje conduction system pacing for pacing-induced cardiomyopathy: a systematic literature review and meta-analysis

Background: Upgrading to His-Purkinje conduction system pacing (HPCSP) has been proven to reverse ventricular remodeling and improve cardiac function in patients with pacing-induced cardiomyopathy (PICM). This meta-analysis aimed to assess the efficacy and clinical benefit of upgrading to HPCSP in patients with PICM after chronic right ventricular pacing (RVP).

Methods: We systematically searched PubMed, Cochrane Library, and Embase for relevant articles from databases' establishment to April 22, 2022. Clinical outcomes and pacing parameters included left ventricular ejection fraction (LVEF) pre-RVP, pre-HPCSP, and during follow-up, New York Heart Association (NYHA) functional class at baseline and follow-up, lead-related complications, heart failure hospitalization (HFH), all-cause mortality, pacing thresholds at implant and during follow-up, and QRS duration (QRSd) pre-RVP, pre-HPCSP, and during follow-up.

Results: A total of 6 articles including 144 patients were enrolled in this meta-analysis. QRSd increased from 127 ± 29 ms at baseline to 175 ± 19 ms (P < 0.001) during RVP and then significantly narrowed to 116 ± 18 ms (P < 0.001) after upgrading to HPCSP. During a mean follow-up of 17.9 ± 10.5 months, LVEF improved from 35 ± 8% pre-HPSCP to 48 ± 12% after upgrading to HPCSP (P < 0.001). The capture thresholds were 1.2 ± 0.9 V at baseline and increased slightly during follow-up. NYHA functional class improved significantly from 2.7 ± 0.8 to 1.9 ± 0.8 during follow-up (P < 0.001).

Conclusion: Our meta-analysis indicates that upgrading to HPCSP in patients with PICM is feasible and efficient, as it significantly improves electrical synchrony and cardiac function.