Background
Conduction system pacing (CSP) using His bundle pacing (HBP) or left bundle branch
area pacing (LBBAP) has emerged as an alternative to right ventricular pacing (RVP).
Comparative data on the risk of complications between CSP and RVP are lacking.
Objective
This prospective, multicenter, observational study aimed to compare the long-term
risk of device-related complications between CSP and RVP.
Methods
A total of 1029 consecutive patients undergoing pacemaker implantation with CSP (including
HBP and LBBAP) or RVP were enrolled. Propensity score matching for baseline characteristics
yielded 201 matched pairs. The rate and nature of device-related complications occurring
during follow-up were prospectively collected and compared between the 2 groups.
Results
During a mean follow-up duration of 18 months, device-related complications were observed
in 19 patients: 7 in RVP (3.5%) and 12 in CSP (6.0%) (P = .240). On dividing the matched cohort into 3 groups with similar baseline characteristics
according to pacing modality (RVP, n = 201; HBP, n = 128; LBBAP, n = 73), patients
with HBP showed a significantly higher rate of device-related complications than did
patients with RVP (8.6% vs 3.5%; P = .047) and patients with LBBAP (8.6% vs 1.3%; P = .034). Patients with LBBAP showed a rate of device-related complications similar
to that of patients with RVP (1.3% vs 3.5%; P = .358). Most of the complications observed in patients with HBP (63.6%) were lead
related.
Conclusion
Globally, CSP was associated with a risk of complications similar to that of RVP.
Considering HBP and LBBAP separately, HBP showed a significantly higher risk of complications
than did both RVP and LBBAP whereas LBBAP showed a risk of complications similar to
that of RVP.
Keywords
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Article info
Publication history
Published online: March 09, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Disclosures: The authors have no conflicts to disclose.
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