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Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with
Karol Curila1, Jan Mizner1, Jan Morava2
1Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia.
Insights
Conduction system pacing (CSP) showed a smaller decline in left ventricular ejection fraction (LVEF) compared to right ventricular pacing (RVP) in patients with severe conduction disease. Both pacing methods had similar clinical outcomes and complication rates.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Conduction system pacing (CSP) is an alternative to traditional right ventricular pacing (RVP) for bradycardia patients.
- Atrioventricular conduction disease necessitates pacemaker implantation.
Purpose of the Study:
- To compare the efficacy and safety of CSP versus RVP in patients indicated for pacemaker implantation due to atrioventricular conduction disease.
Main Methods:
- A randomized controlled trial involving 249 patients comparing CSP (His bundle or left bundle branch area pacing) with RVP.
- The primary endpoint was the change in left ventricular ejection fraction (LVEF) over 12 months.
- A composite clinical endpoint included cardiovascular death, CRT upgrade, or heart failure hospitalization.
Main Results:
- CSP demonstrated a smaller decline in LVEF (-2% vs -4%, P = .03) compared to RVP.
- A significant decrease in LVEF (≥10%) was less frequent in the CSP group (5% vs 16%, P = .01).
- No significant differences were observed in the composite clinical outcome or procedural complication rates between CSP and RVP.
Conclusions:
- CSP is associated with better preservation of left ventricular ejection fraction compared to RVP in patients with severe conduction disease after one year.
- Both CSP and RVP are comparable in terms of clinical outcomes and procedural safety.
Background:
Conduction system pacing (CSP) replaces right ventricular pacing (RVP) in bradycardia patients.
Objective:
To compare CSP vs RVP in patients with pacemaker indication due to atrioventricular conduction disease.
Methods:
This study randomized patients to CSP or RVP in 1:1 ratio and followed them for 12 months. CSP received either His bundle pacing or left bundle branch area pacing; The primary end point was a change in the left ventricular ejection fraction (LVEF). The combined composite clinical end point consisted of cardiovascular death, cardiac resynchronization therapy upgrade, or hospitalization for heart failure.
Results:
Of 249 patients, 125 were randomized to RVP and 124 to CSP; there were no differences between clinical parameters. In CSP, 10 patients received His bundle pacing, 96 left bundle branch area pacing, 15 deep septal pacing, and 3 RVP. Procedural and fluoroscopy times were longer in CSP vs RVP (63 vs 40 and 7 vs 3 minutes; P < .001). In the intention-to-treat analysis, the LVEF decline in CSP was smaller than RVP (-2% vs -4%, P = .03), and a LVEF decrease ≥ 10% occurred more often in RVP 19 (16%) than CSP 6 (5%), P = .01. There was no difference in the composite clinical outcome between RVP and CSP (9 vs 4, P = .15). There was also no difference in procedural complications (9 in RVP vs 2 in CSP, P = .09).
Conclusion:
In patients with severe conduction disease, CSP led to a smaller LVEF decline than RVP after 1 year of pacing. Both pacing methods had similar rates of clinical end points and procedural complications.
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