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Multicenter Study
. 2023 Jun;20(6):863-871.
doi: 10.1016/j.hrthm.2023.02.018. Epub 2023 Feb 24.

Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

Fatima M Ezzeddine  1 , Serafim M Pistiolis  2 , Margarida Pujol-Lopez  3 , Michael Lavelle  4 , Elaine Y Wan  4 , Kristen K Patton  5 , Melissa Robinson  5 , Adi Lador  6 , Kamala Tamirisa  7 , Saima Karim  8 , Cecilia Linde  9 , Ratika Parkash  10 , Ulrika Birgersdotter-Green  11 , Andrea M Russo  12 , Mina Chung  13 , Yong-Mei Cha  14
Affiliations
Multicenter Study

Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

Fatima M Ezzeddine et al. Heart Rhythm. 2023 Jun.

Abstract

Background: Whether conduction system pacing (CSP) is an alternative option for cardiac resynchronization therapy (CRT) in patients with heart failure remains an area of active investigation.

Objective: The purpose of this study was to assess the echocardiographic and clinical outcomes of CSP compared to biventricular pacing (BiVP).

Methods: This multicenter retrospective study included patients who fulfilled CRT indications and received CSP. Patients with CSP were matched using propensity score matching and compared in a 1:1 ratio to patients who received BiVP. Echocardiographic and clinical outcomes were assessed. Response to CRT was defined as an absolute increase of ≥5% in left ventricular ejection fraction (LVEF) at 6 months post-CRT.

Results: A total of 238 patients were included. Mean age was 69.8 ± 12.5 years, and 66 (27.7%) were female. Sixty-nine patients (29%) had His-bundle pacing, 50 (21%) had left bundle branch area pacing, and 119 (50%) had BiVP. Mean follow-up duration in the CSP and BiVP groups was 269 ± 202 days and 304 ± 262 days, respectively (P = .293). The proportion of CRT responders was greater in the CSP group than in the BiVP group (74% vs 60%, respectively; P = .042). On Kaplan-Meier analysis, there was no statistically significant difference in the time to first heart failure hospitalization (log-rank P = .78) and overall survival (log-rank P = .68) between the CSP and BiVP groups.

Conclusion: In patients with heart failure and reduced ejection fraction, CSP resulted in greater improvement in LVEF compared to BiVP. Large-scale randomized trials are needed to validate these outcomes and further investigate the different options available for CSP.

Keywords: Cardiac resynchronization therapy; Conduction system pacing; Heart failure; His-bundle pacing; Left bundle branch area pacing; Physiological pacing.

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Conflict of interest statement

Conflicts of interest: Dr. Pujol-Lopez has received speaker honoraria from Medtronic.

All other authors have no relevant conflict of interest to disclose.

Figures

Figure 1:
Figure 1:. Flowchart of the patients included in the study
Abbreviations: BiVP: biventricular pacing; CS: coronary sinus; CSP: conduction system pacing; CRT: cardiac resynchronization therapy; HBP: His bundle pacing; LBBAP: left bundle branch area pacing.
Figure 2:
Figure 2:. Examples of electrocardiograms before and after cardiac resynchronization therapy in patients with conduction system pacing and biventricular pacing
Figure 3:
Figure 3:. Echocardiographic outcomes before and after cardiac resynchronization therapy in patients with conduction system pacing and biventricular pacing
Abbreviations: CRT: cardiac resynchronization therapy; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic dimension; MR: mitral regurgitation; RV: right ventricular.
Figure 4:
Figure 4:. Kaplan-Meier curves demonstrating comparison of time to first heart failure hospitalization between patients with conduction system pacing and biventricular pacing
Figure 5:
Figure 5:. Kaplan-Meier curves demonstrating survival comparison between patients with conduction system pacing and biventricular pacing
See this image and copyright information in PMC

References

    1. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–2150. - PubMed
    1. Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. New England Journal of Medicine. 2009;361(14):1329–1338. - PubMed
    1. Cleland JG, Daubert J-C, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine. 2005;352(15):1539–1549. - PubMed
    1. Tang AS, Wells GA, Talajic M, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. New England Journal of Medicine. 2010;363(25):2385–2395. - PubMed
    1. Abraham WT, Hayes DL. Cardiac resynchronization therapy for heart failure. Circulation. 2003;108(21):2596–2603. - PubMed

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