Mid-Term Cardiac Outcomes in Prosthetic Valve Surgery and HF Patients Across EF After CSP

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Heart Failure Management

Background:

• Clinical outcomes of conduction system pacing (CSP) in patients with prosthetic valve surgery (PVS) and heart failure (HF) are not well-established.
• This population presents unique challenges for pacing due to prior cardiac surgery and underlying heart conditions.

Purpose of the Study:

• To evaluate the feasibility, safety, and clinical impact of CSP in patients with PVS and HF.
• To assess the effects of CSP on cardiac structure and function across different left ventricular ejection fraction (LVEF) categories.

Main Methods:

• A consecutive series of patients with atrioventricular block post-PVS and HF history undergoing CSP were enrolled.
• Outcomes were analyzed based on LVEF: reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF).
• Key assessments included LVEF, left ventricular end-diastolic diameter (LVEDD), left atrial diameter, and New York Heart Association (NYHA) class.

Main Results:

• CSP was successful in 93.75% of patients.
• All LVEF cohorts showed improved LVEDD.
• The HFrEF group demonstrated significant improvements in LVEF, left atrial diameter, and NYHA class.
• No deterioration was observed in HFmrEF/HFpEF groups.
• Absence of rheumatic heart disease (RHD) was an independent predictor for complete LVEF/LVEDD normalization in 26.47% of HFrEF patients.
• No major complications like cardiac perforation, thrombosis, or pacemaker-induced cardiomyopathy (PICM) occurred during a mean follow-up of 25.49 months.

Conclusions:

• CSP is a feasible and safe pacing strategy for PVS patients with HF.
• CSP facilitates cardiac reverse remodeling and mitigates PICM risk across all LVEF categories.
• Non-RHD etiology predicts complete normalization of cardiac function in a significant subset of HFrEF patients.