Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block.
AV block
His-Purkinje conduction system pacing
cardiac resynchronization therapy
left ventricular dysfunction
mitral regurgitation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
11
03
2022
received:
12
01
2022
accepted:
13
05
2022
pubmed:
19
5
2022
medline:
21
9
2022
entrez:
18
5
2022
Statut:
ppublish
Résumé
It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT. Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up. HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02). HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
Sections du résumé
BACKGROUND
It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT.
METHODS
Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up.
RESULTS
HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02).
CONCLUSION
HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
Identifiants
pubmed: 35583311
doi: 10.1111/pace.14535
pmc: PMC9796875
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1115-1123Informations de copyright
© 2022 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
Références
Heart Rhythm. 2018 Mar;15(3):413-420
pubmed: 29031929
Eur Heart J. 2019 Nov 21;40(44):3641-3648
pubmed: 31504437
J Am Coll Cardiol. 2006 May 16;47(10):1927-37
pubmed: 16697307
Heart Rhythm. 2015 Jul;12(7):1548-57
pubmed: 25828601
JAMA. 2002 Dec 25;288(24):3115-23
pubmed: 12495391
Eur J Heart Fail. 2018 Jun;20(6):1039-1051
pubmed: 29457358
J Am Coll Cardiol. 2019 Jul 9;74(1):157-159
pubmed: 31078637
Heart Rhythm. 2019 Dec;16(12):1791-1796
pubmed: 31233818
J Card Fail. 2010 Apr;16(4):293-300
pubmed: 20350695
Pacing Clin Electrophysiol. 2022 Sep;45(9):1115-1123
pubmed: 35583311
J Am Coll Cardiol. 2018 Dec 18;72(24):3112-3122
pubmed: 30545450
Can J Cardiol. 2021 Feb;37(2):319-328
pubmed: 32387225
N Engl J Med. 2013 Apr 25;368(17):1585-93
pubmed: 23614585
JACC Clin Electrophysiol. 2020 Jul;6(7):849-858
pubmed: 32703568
Europace. 2019 Nov 1;21(11):1694-1702
pubmed: 31322651
JACC Clin Electrophysiol. 2021 Feb;7(2):135-147
pubmed: 33602393
Eur Heart J. 2021 Sep 14;42(35):3427-3520
pubmed: 34455430
J Am Coll Cardiol. 2018 Aug 21;72(8):927-947
pubmed: 30115232
J Interv Card Electrophysiol. 2021 Oct;62(1):63-73
pubmed: 32954478
JACC Clin Electrophysiol. 2021 Nov;7(11):1422-1432
pubmed: 34167929
Eur J Heart Fail. 2014 Jul;16(7):802-9
pubmed: 24863467