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Ablate and pace: Comparison of outcomes between conduction system pacing and biventricular pacing
Pietro Palmisano1, Matteo Ziacchi2, Gabriele Dell'Era3
1Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.
Insights
Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), are safe alternatives to biventricular pacing (BVP) for patients undergoing ablate and pace procedures. Left bundle branch area pacing demonstrated improved procedural efficiency and device longevity.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Conduction system pacing (CSP), encompassing His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), are emerging alternatives to biventricular pacing (BVP).
- These pacing methods are considered for patients requiring an ablate and pace (A&P) strategy.
- This study evaluates the comparative outcomes of BVP versus CSP in A&P patients.
Purpose of the Study:
- To compare the clinical outcomes between BVP and CSP in patients undergoing A&P.
- To assess the rate and nature of device-related complications.
- To evaluate heart failure (HF) hospitalization rates.
Main Methods:
- A prospective, multicenter, observational study.
- Enrollment of consecutive patients undergoing A&P.
- Prospective assessment of device-related complications and HF hospitalization risk.
Main Results:
- 373 patients were enrolled: 263 (BVP), 68 (HBP), and 42 (LBBAP).
- Left bundle branch area pacing (LBBAP) showed shorter procedural/fluoroscopy times and lower acute capture thresholds compared to BVP and HBP.
- At 12 months, LBBAP maintained lower thresholds and longer battery longevity; complication and HF hospitalization rates were similar across all groups.
Conclusions:
- CSP is a feasible pacing option for A&P with midterm safety comparable to BVP.
- LBBAP offers advantages in procedural efficiency and device longevity.
- CSP, particularly LBBAP, presents a viable alternative to BVP in A&P strategies.
Background:
Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), have been proposed as alternatives to biventricular pacing (BVP) in patients scheduled for ablate and pace (A&P) strategy. The aim of this study was to compare the clinical outcomes, including the rate and nature of device-related complications, between BVP and CSP in a cohort of patients undergoing A&P.
Methods:
Prospective, multicenter, observational study, enrolling consecutive patients undergoing A&P. The risk of device-related complications and of heart failure (HF) hospitalization was prospectively assessed.
Results:
A total of 373 patients (75.3 ± 8.7 years, 53.9% male, 68.9% with NYHA class ≥III) were enrolled: 263 with BVP, 68 with HBP, and 42 with LBBAP. Baseline characteristics of the three groups were similar. Compared to BVP and HBP, LBBAP was associated with the shortest mean procedural and fluoroscopy times and with the lowest acute capture thresholds (all p < .05). At 12-month follow-up LBBAP maintained the lowest capture thresholds and showed the longest estimated residual battery longevity (all p < .05). At 12-months follow-up the three study groups showed a similar risk of device-related complications (5.7%, 4.4%, and 2.4% for BVP, HBP, and LBBAP, respectively; p = .650), and of HF hospitalization (2.7%, 1.5%, and 2.4% for BVP, HBP, and LBBAP, respectively; p = .850).
Conclusions:
In the setting of A&P, CSP is a feasible pacing modality, with a midterm safety profile comparable to BVP. LBBAP offers the advantage of reducing procedural times and obtaining lower and stable capture thresholds, with a positive impact on the device longevity.
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