Conduction system pacing for ventricular pacing requirement is feasible and effective on patients with hypertrophic
Jia Jing-Jing1, Wang Ke-Xin1, Jing Zhao-Meng1
1Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Insights
Conduction system pacing, including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), is safe and effective for hypertrophic cardiomyopathy patients with heart failure. These pacing methods improved cardiac function, particularly in those with reduced ejection fraction.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Hypertrophic cardiomyopathy (HCM) can lead to heart failure (HF) and conduction abnormalities.
- Conduction system pacing (CSP) offers a potential alternative to traditional pacing in such complex cases.
Purpose of the Study:
- To evaluate the feasibility and safety of His-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with HCM and HF.
- To assess the impact of CSP on cardiac function and clinical outcomes in this patient cohort.
Main Methods:
- A consecutive series of 27 patients with HCM and HF (interventricular septal thickness ≥ 13 mm) undergoing CSP (ventricular pacing > 40%) were enrolled.
- LBBP was preferred, with HBP as an alternative based on septal thickness or procedural success.
- Patients were followed for at least one year, with data collected on clinical, echocardiographic, and electrocardiographic parameters.
Main Results:
- CSP demonstrated high feasibility with only 11.11% failure rate across LBBP and HBP procedures.
- No significant worsening of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), or QRS duration was observed post-pacing.
- Patients with LVEF < 50% showed significant improvements in LVEF, LVEDD, left atrial diameter (LAD), and NYHA grade after CSP.
Conclusions:
- CSP, including HBP and LBBP, is a safe and feasible strategy for managing patients with HCM and cardiac dysfunction.
- CSP did not compromise cardiac performance and notably improved function in patients with reduced LVEF.
- HBP serves as a viable alternative to LBBP, especially in cases with significantly thickened interventricular septa.
Objective:
We aimed to evaluate the feasibility and safety of his-bundle pacing (HBP) and left bundle branch pacing (LBBP) in patients with hypertrophic cardiomyopathy (HCM) and heart failure (HF).
Methods:
Patients with HF and interventricular septal thickness (IVST) ≥ 13 mm resulted from HCM, who accepted conduction system pacing (CSP) with a percentage of ventricular pacing > 40% from May 2018 to April 2022 were consecutively enrolled in our center. LBBP was preferred and HBP was the alternative therapy unless IVST ≥ 16 mm or LBBP failed, whereas LBBP would be the alternative therapy if HBP failed in patients with IVST ≥ 16 mm. All patients were followed up for at least one year. Data including clinical, echocardiographic parameters and electrocardiogram measurements, were collected and evaluated in patients with and without left ventricular ejection fraction (LVEF) < 50%.
Results:
A total of 27 patients (65.93 ± 9.09 years old) were enrolled and only 3 patients failed in CSP (11.11%) via LBBP (6/13) and HBP (18/21) procedures. LVEF (P = 0.521), left ventricular end-diastolic diameter (LVEDD) (P = 0.816), and QRS duration (P = 0.928) did not worsen after CSP, and left atrial diameter (LAD) (49.58 ± 8.99 mm vs.47.04 ± 9.82 mm, P = 0.045) tended to improve slightly after 19.19 ± 7.71 months follow-up. Of note, LVEF (39.22%±7.51% vs. 45.22%±9.59%, P = 0.015), LVEDD (52.11 ± 10.10 mm vs. 48.33 ± 9.07 mm, P = 0.037), LAD (50.33 ± 8.93 mm vs. 46.11 ± 5.97 mm, P = 0.013) and New York Heart Association (NYHA) grade (2.67 ± 0.5 vs. 1.38 ± 1.02, P = 0.029) improved in 9 patients with LVEF < 50%, whereas LVEF (P = 0.372), LVEDD (P = 0.665), LAD (P = 0.093) and NYHA grade (P = 0.452) did not deteriorate in patients with preserved ejection fraction.
Conclusion:
CSP was safe and feasible in patients with HCM and cardiac dysfunction, and did not worsen cardiac performance especially in patients with LVEF < 50%. HBP might be an effective alternative to LBBP in patients with significantly thickened interventricular septum.
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