Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease.

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Left ventricular systolic dysfunction due to dyssynchrony is a significant issue in congenital heart disease (CHD).
• Conventional cardiac resynchronization therapy (CRT) offers benefits, but its comparative efficacy against cardiac conduction system pacing (CSP) remains unestablished.

Purpose of the Study:

• To compare the clinical outcomes of CSP versus conventional CRT in CHD patients with biventricular, systemic left ventricular anatomy.

Main Methods:

• A retrospective analysis compared 65 CSP cases from 7 centers with propensity score-matched conventional CRT controls.
• Outcomes assessed included lead performance, changes in left ventricular ejection fraction (LVEF), and QRS duration at 12 months.

Main Results:

• CSP was successfully achieved in 65 patients, with left bundle branch area pacing (LBBAP) showing superior electrical parameters compared to His bundle pacing (HBP).
• Improvement in LVEF was non-inferior between CSP and CRT (9.0% vs. 6.0%), while CSP demonstrated significantly greater QRS narrowing (35 ms vs. 14 ms).
• Complication rates were similar between the two groups (12% for CSP vs. 16% for CRT).

Conclusions:

• Cardiac conduction system pacing (CSP) is a reliably achievable option for biventricular, systemic left ventricular CHD patients.
• CSP demonstrated comparable LVEF improvement and superior QRS narrowing versus conventional CRT at one year.
• Left bundle branch area pacing (LBBAP) exhibited better electrical pacing parameters than His bundle pacing (HBP) within the CSP group.