Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A
Fatima M Ezzeddine1, Serafim M Pistiolis2, Margarida Pujol-Lopez3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Conduction system pacing (CSP) shows greater improvement in left ventricular ejection fraction (LVEF) for heart failure patients compared to biventricular pacing (BiVP). Further research is needed to confirm these findings.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Conduction system pacing (CSP) is being investigated as an alternative to cardiac resynchronization therapy (CRT) for heart failure patients.
- The efficacy of CSP versus traditional biventricular pacing (BiVP) requires further evaluation.
Purpose of the Study:
- To compare echocardiographic and clinical outcomes between CSP and BiVP in patients meeting CRT criteria.
- To assess the response to CRT defined by left ventricular ejection fraction (LVEF) improvement.
Main Methods:
- A multicenter retrospective study matched 1:1 using propensity scores.
- Included patients with heart failure who received either CSP or BiVP.
- Assessed LVEF changes and clinical endpoints at 6 months post-implantation.
Main Results:
- The CSP group demonstrated a higher proportion of CRT responders (74% vs. 60%, P=.042).
- No significant differences were observed in heart failure hospitalizations or overall survival between the groups.
- CSP led to a greater improvement in LVEF compared to BiVP.
Conclusions:
- CSP is a promising alternative for CRT, showing superior LVEF improvement in heart failure patients.
- Larger randomized trials are necessary to validate these findings and explore various CSP techniques.
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.
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