Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Cardiac resynchronization therapy (CRT) is standard for heart failure with reduced ejection fraction.
• The efficacy of His-Purkinje conduction system pacing (HPCSP) as an alternative to biventricular CRT (BiVCRT) is not well-established.
• Left ventricular dysfunction often necessitates ventricular pacing due to atrioventricular block.

Purpose of the Study:

• To compare echocardiographic and clinical outcomes of HPCSP versus BiVCRT.
• To evaluate HPCSP as a potential alternative to BiVCRT in patients with left ventricular dysfunction and atrioventricular block.

Main Methods:

• Retrospective comparison of consecutive HPCSP patients with a historical BiVCRT cohort.
• 1:1 matching based on age, LVEF, atrial fibrillation, renal function, and cardiomyopathy type.
• Responders defined by survival, no heart transplant, and LVEF increase ≥5 points at 6 months.

Main Results:

• HPCSP achieved 92.5% success rate; 76% responders vs. 64% in BiVCRT (p=0.33).
• Similar LVEF improvement (10% vs. 7%, p=0.24) between HPCSP and BiVCRT.
• HPCSP significantly improved mitral regurgitation (82% vs. 25%, p=0.02) and NYHA class (1 point vs. 0.5, p=0.02).

Conclusions:

• HPCSP is a promising alternative to BiVCRT for patients with LVEF ≤45% and atrioventricular block.
• HPCSP significantly improves LVEF, mitral regurgitation, and functional status.
• HPCSP offers comparable efficacy to BiVCRT with potential advantages in specific patient groups.