Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• His bundle pacing (HBP) is the most physiologic ventricular pacing method.
• Nonselective HBP (NS-HBP) can lead to right ventricular septal pre-excitation and wider QRS duration compared to selective HBP (S-HBP).

Purpose of the Study:

• To compare the clinical outcomes of NS-HBP versus S-HBP in patients with bradyarrhythmic indications.

Main Methods:

• A retrospective analysis of 350 patients from HBP registries who received HBP for bradyarrhythmia.
• Patients were classified as NS-HBP (n=232) or S-HBP (n=118) based on QRS morphology at 3-month follow-up.
• The primary outcome was a composite of all-cause mortality or heart failure hospitalization.

Main Results:

• The NS-HBP group had a higher prevalence of male patients, infranodal AV block, ischemic cardiomyopathy, and permanent atrial fibrillation.
• The primary endpoint occurred in 35% of NS-HBP patients versus 19% of S-HBP patients (HR 1.38; 95% CI 0.87-2.20; P=0.17).
• Subgroup analyses in high-risk patients did not reveal an increased risk with NS-HBP.

Conclusions:

• NS-HBP demonstrated comparable outcomes to S-HBP concerning mortality and heart failure hospitalization.
• Multicenter, risk-matched studies are recommended to validate these findings in His bundle pacing.