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Clinical outcomes of conduction system pacing compared to biventricular pacing in patients with mid-range ejection
Jiaojiao Tang1,2, Nathan W Kong3, Andrew Beaser1
1Center for Arrhythmia Care, Heart and Vascular Institute, The University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA.
Insights
Conduction system pacing (CSP) and biventricular pacing (BiVP) show similar mid-term clinical outcomes in heart failure patients with mid-range ejection fraction. Both pacing methods effectively improve left ventricular ejection fraction (LVEF) with comparable safety profiles.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Limited comparative data exists for conduction system pacing (CSP) versus biventricular pacing (BiVP) in heart failure (HF) patients with mid-range left ventricular ejection fraction (LVEF).
- Understanding the efficacy and safety of alternative pacing strategies is crucial for optimizing HF treatment.
Purpose of the Study:
- To compare the clinical outcomes of CSP and BiVP in patients diagnosed with HF and mid-range LVEF.
- To evaluate differences in lead performance, LVEF changes, HF hospitalizations, and composite clinical outcomes.
Main Methods:
- Retrospective analysis of patients with mid-range LVEF (35-50%) who underwent either CSP or BiVP.
- Comparison of procedural metrics, QRS duration, lead thresholds, battery longevity, LVEF, HF hospitalizations, and a composite clinical outcome.
- Included His bundle pacing and left bundle branch area pacing within the CSP group.
Main Results:
- No significant differences in procedural time, fluoroscopy time, or lead thresholds were observed between CSP and BiVP groups.
- Both pacing strategies led to significant improvements in LVEF during mid-term follow-up.
- HF hospitalizations and composite clinical outcomes were comparable between the CSP and BiVP groups.
Conclusions:
- Conduction system pacing (CSP) demonstrates comparable mid-term clinical outcomes and LVEF improvements to biventricular pacing (BiVP) in heart failure patients with moderately reduced ejection fraction.
- CSP represents a viable alternative pacing strategy in this patient population, offering similar efficacy and safety.
Background:
There is a paucity of data comparing conduction system pacing (CSP) to biventricular pacing (BiVP) in patients with heart failure (HF) with mid-range left ventricular ejection fraction (LVEF).
Objective:
Compare the clinical outcomes of patients with mid-range LVEF undergoing CSP versus BiVP.
Methods:
Patients with mid-range LVEF (> 35 to 50%) undergoing CSP or BiVP were retrospectively identified. Lead performance, LVEF, HF hospitalization, and clinical composite outcome including upgrade to cardiac resynchronization therapy and mortality were compared.
Results:
A total of 36 patients (20 BiVP, 16 CSP--14 His bundle pacing, 4 left bundle branch area pacing) were analyzed. The mean age was 73 ± 15, 44% were female, and the mean LVEF was 42 ± 5%. Procedural and fluoroscopy time was comparable between the two groups. QRS duration was significantly shorter for the CSP group compared to the BiVP group (P < 0.001). During a mean follow-up of 47 ± 36 months, no significant differences were found in thresholds or need for generator change due to early battery depletion. LVEF improved in both groups (41.5 ± 4.5% to 53.9 ± 10.9% BiVP, P < 0.001; 41.6 ± 5.3% to 52.5 ± 8.3% CSP, P < 0.001). There were no significant differences in HF hospitalizations (P = 0.71) or clinical composite outcomes (P = 0.07).
Conclusion:
Among patients with HF with moderately reduced ejection fraction, CSP appears associated with similar improvements in LVEF and had similar clinical outcomes as BiVP in mid-term follow-up.
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