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 ≥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 having heart failure with 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.
Keywords
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Article info
Publication history
Published online: February 24, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This research study is supported by NIH R01 HL134864 funding. Disclosures: Dr Pujol-Lopez has received speaker honoraria from Medtronic. All other authors have no conflicts of interest to disclose.
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