Long-Term Outcomes in Patients With Relatively High His-Bundle Capture Threshold After Permanent His-Bundle Pacing -
Ryo Watanabe1, Hiroyuki Kato2, Satoshi Yanagisawa3,4
1Department of Cardiology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital Nagoya Japan.
Insights
Patients with high His-bundle (HB) capture thresholds during permanent His-bundle pacing (HBP) have a greater risk of lead issues and adverse clinical events. A high baseline HB capture threshold predicts poorer outcomes in HBP patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Understanding outcomes for patients with high His-bundle (HB) capture thresholds during permanent His-bundle pacing (HBP) is crucial.
- This study investigates the HB capture threshold changes and prognosis in patients with high versus low baseline thresholds.
Purpose of the Study:
- To compare the evolution of HB capture thresholds and clinical outcomes between patients with high and low baseline HB capture thresholds.
- To identify predictors of adverse events in patients undergoing HBP.
Main Methods:
- Forty-nine patients undergoing permanent HBP were stratified into low (<1.25 V) and high (1.25-2.49 V) baseline HB capture threshold groups.
- HB capture thresholds were monitored post-implantation up to 6 months and then biannually.
- Clinical events, including device-related issues and mortality, were compared between groups.
Main Results:
- The high-threshold group exhibited a trend towards higher rates of HB capture threshold rise (≥2.5 V), HBP abandonment, lead revision, and clinical events.
- A baseline HB capture threshold of ≥1.25 V was identified as an independent predictor of clinical events.
- Significant differences were observed in the incidence of HB capture threshold rise (50% vs. 14%; P=0.023).
Conclusions:
- A relatively high HB capture threshold at implantation is linked to an increased risk of HBP abandonment.
- Elevated HB capture thresholds are associated with a higher likelihood of lead revision.
- Patients with high HB capture thresholds face poorer clinical outcomes, including adverse cardiovascular events.
Background:
Outcomes in patients with relatively high His-bundle (HB) capture thresholds at implantation are unknown. This study aimed to compare changes in the HB capture threshold and prognosis between patients with a relatively high threshold and those with a low threshold.
Methods And Results:
Forty-nine patients who underwent permanent HB pacing (HBP) were divided into two groups: low (<1.25 V at 1.0 ms; n=35) and high (1.25-2.49 V; n=14) baseline HB capture threshold groups. The HB capture threshold was evaluated at implantation, and after 1 week, 1, 3, and 6 months, and every 6 months thereafter. HB capture threshold rise was defined as threshold rise ≥1.0 V at 1.0 ms compared with implantation measures. We compared outcomes between the groups. During a mean follow-up period of 34.6 months, the high-threshold group showed a trend toward a higher incidence of HB capture threshold of ≥2.5 V (50% vs. 14%; P=0.023), HBP abandonment (29% vs. 8.6%; P=0.091), lead revision (21% vs. 2.9%; P=0.065), and clinical events (all-cause death, heart failure hospitalization, and new-onset or progression of atrial fibrillation; 50% vs. 23%; P=0.089) than the low-threshold group. A baseline HB capture threshold of ≥1.25V was an independent predictor of clinical events.
Conclusions:
A relatively high HB capture threshold is associated with increased risk of HBP abandonment, lead revision, and poor clinical outcomes.
