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

Peng Li1, Xiao-Xiao Jiang1, Yi-Heng Yang1

  • 1Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.

Pacing and Clinical Electrophysiology : PACE
|June 5, 2025
PubMed

Insights

Conduction system pacing (CSP) is a safe and feasible option for patients with prosthetic valve surgery and heart failure. This pacing method promotes reverse cardiac remodeling and reduces the risk of pacemaker-induced cardiomyopathy, with over 25% of heart failure with reduced ejection fraction patients achieving normalization.

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.
Abstract

Keywords:
conduction system pacingheart failureleft ventricular ejection fractionprosthetic valve surgery

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