Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

Fatima M. Ezzeddine, Serafim M. Pistiolis, Margarida Pujol-Lopez, Michael Lavelle, Elaine Y. Wan, Kristen K. Patton, Melissa Robinson, Adi Lador, Kamala Tamirisa, Saima Karim, Cecilia Linde, Ratika Parkash, Ulrika Birgersdotter-Green, Andrea M. Russo, Mina Chung, Yong Mei Cha

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background: Whether conduction system pacing (CSP) is an alternative option for cardiac resynchronization therapy (CRT) in patients with heart failure remains an area of active investigation. Objective: The purpose of this study was to assess the echocardiographic and clinical outcomes of CSP compared to biventricular pacing (BiVP). Methods: This multicenter retrospective study included patients who fulfilled CRT indications and received CSP. Patients with CSP were matched using propensity score matching and compared in a 1:1 ratio to patients who received BiVP. Echocardiographic and clinical outcomes were assessed. Response to CRT was defined as an absolute increase of ≥5% in left ventricular ejection fraction (LVEF) at 6 months post-CRT. Results: A total of 238 patients were included. Mean age was 69.8 ± 12.5 years, and 66 (27.7%) were female. Sixty-nine patients (29%) had His-bundle pacing, 50 (21%) had left bundle branch area pacing, and 119 (50%) had BiVP. Mean follow-up duration in the CSP and BiVP groups was 269 ± 202 days and 304 ± 262 days, respectively (P = .293). The proportion of CRT responders was greater in the CSP group than in the BiVP group (74% vs 60%, respectively; P = .042). On Kaplan-Meier analysis, there was no statistically significant difference in the time to first heart failure hospitalization (log-rank P = .78) and overall survival (log-rank P = .68) between the CSP and BiVP groups. Conclusion: In patients with heart failure and reduced ejection fraction, CSP resulted in greater improvement in LVEF compared to BiVP. Large-scale randomized trials are needed to validate these outcomes and further investigate the different options available for CSP.

Original languageEnglish (US)
Pages (from-to)863-871
Number of pages9
JournalHeart Rhythm
Volume20
Issue number6
DOIs
StatePublished - Jun 2023

Keywords

  • Cardiac resynchronization therapy
  • Conduction system pacing
  • Heart failure
  • His-bundle pacing
  • Left bundle branch area pacing
  • Physiological pacing
  • Ventricular Function, Left/physiology
  • Cardiac Conduction System Disease/therapy
  • Humans
  • Middle Aged
  • Male
  • Treatment Outcome
  • Stroke Volume
  • Heart Failure/diagnosis
  • Cardiac Resynchronization Therapy/methods
  • Electrocardiography/methods
  • Aged, 80 and over
  • Female
  • Aged
  • Retrospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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