Ablate and pace: Comparison of outcomes between conduction system pacing and biventricular pacing

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.