Permanent His-bundle pacing: Long-term lead performance and clinical outcomes

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Right ventricular pacing (RVP) is linked to increased risks of heart failure and mortality.
• His-bundle pacing (HBP) presents a more physiological pacing strategy compared to RVP.

Purpose of the Study:

• To evaluate the long-term performance and clinical outcomes of permanent His-bundle pacing (HBP) versus right ventricular pacing (RVP).

Main Methods:

• A comparative study involving patients undergoing pacemaker implantation, with attempts at HBP or RVP.
• Follow-up over 5 years, tracking left ventricular ejection fraction (LVEF), pacing parameters, and lead/generator issues.
• Primary outcome: combined endpoint of death or heart failure hospitalization (HFH).

Main Results:

• Successful HBP in 80% of attempts; RVP in 98 patients.
• LVEF remained stable with HBP, but declined significantly with RVP.
• Pacing-induced cardiomyopathy was lower with HBP (2% vs. 22%).
• Death or HFH was lower with HBP (32% vs. 53%) at 5 years.
• HBP group had higher rates of lead revisions (6.7% vs. 3%) and generator changes (9% vs. 1%).

Conclusions:

• Permanent HBP is associated with reduced death or HFH compared to RVP in long-term follow-up.
• HBP requires more frequent lead revisions and generator replacements.