Clinical Outcomes in Conduction System Pacing Compared to Right Ventricular Pacing in Bradycardia

Tan, Esther; Soh, Rodney; Lee, Jie-Ying; Boey, Elaine; Ho, Kian-Hui; Aguirre, Shana; Leon, Jhobeleen De; Chan, Siew-Pang; Seow, Swee‐Chong; Kojodjojo, Pipin

doi:10.1016/j.jacep.2022.10.016

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…Chronic RV pacing potentially leads to dyssynchronous ventricular activation and subsequent LV dysfunction (i.e., PICM); PICM occurs in ≈12% of patients with chronic RV pacing, although with a significant range between studies 31 . Physiological pacing such as HBP and LBBAP is a novel technique directly activating the specialized conduction system and has reduced all‐cause mortality and HFH compared to RVAP 4,11,12,30,31 . A recent meta‐analysis reported that pacing parameters (capture threshold and R wave amplitude) might be better in LBBAP than in HBP 32 .…”

Section: Discussionmentioning

confidence: 99%

“…31 Physiological pacing such as HBP and LBBAP is a novel technique directly activating the specialized conduction system and has reduced all-cause mortality and HFH compared to RVAP. 4,11,12,30,31 A recent meta-analysis reported that pacing parameters (capture threshold and R wave amplitude) might be better in LBBAP than in HBP. 32 To date, however, there is little evidence comparing clinical outcomes between HBP and LBBAP.…”

Section: Clinical Outcomes After Physiological Pacingmentioning

confidence: 99%

“…Previous studies reported that LBBP was superior to LVSP in enhancing pacing characteristics, such as LVAT and QRS duration. 8,9 LVSP was not part of the success criteria for LBBAP in initial studies, [10][11][12][13][14][15][16][17][18][19] while the latest consensus document has included LVSP for LBBAP. 7 Recent clinical studies have demonstrated that LBBAP led to better outcomes than RVAP 10,11 ; LBBAP boasted a higher success rate and a more consistent pacing capture threshold than HBP.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

Kono,

Kuramitsu,

Fukunaga

et al. 2024

Journal of Arrhythmia

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BackgroundHis bundle pacing (HBP) and left bundle branch area pacing (LBBAP) emerge as better alternatives to right ventricular apical pacing (RVAP) in patients with bradycardia requiring permanent cardiac pacing. We aimed to compare the clinical outcomes of LBBAP, HBP, and RVAP in Japanese patients with bradycardia.MethodsA total of 424 patients who underwent successful pacemaker implantation (HBP, n = 53; LBBAP, n = 75; and RVAP, n = 296) were retrospectively enrolled in this study. The primary study endpoint was the cumulative incidence of heart failure hospitalization (HFH) during the follow‐up.ResultsThe success rate for implantation was higher in the LBBAP group than in the HBP group (94.9% and 81.5%, respectively). Capture threshold increase >1V during the follow‐up occurred in the HBP and RVAP groups (9.4% and 5.1%, respectively), while it did not in the LBBAP group. The cumulative incidence of HFH was significantly lower in the LBBAP group than the RVAP (adjusted hazard ratio, 0.12 [95% confidence interval: 0.02–0.86]; p = .034); it did not differ between the HBP and RVAP groups (adjusted hazard ratio, 0.48 [95% confidence interval: 0.17–1.34]; p = .16). Advanced age, mean percent right ventricular pacing (per 10% increase), left ventricular ejection fraction <50%, and RVAP were associated with HFH.ConclusionsCompared to RVAP and HBP, LBBAP appeared more feasible and effective in patients with bradycardia requiring permanent cardiac pacing.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Outcomes After Physiological Pacingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

Kono,

Kuramitsu,

Fukunaga

et al. 2024

Journal of Arrhythmia

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“…Participants were patients from the Prospective Electrophysiological Ablation and Cardiac implantable Electronic device registry, 17 a prospective cohort comprising patients who underwent cardiac implantable electronic devices at two tertiary hospitals which provided healthcare to >1.5 million residents in the Western part of Singapore. Consecutive patients with BiV were followed since 2012, 3 and those with CSP (LBBP or HBP) since 2018 18,19 .…”

Section: Methodsmentioning

confidence: 99%

Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

Tan

Soh

Lee

et al. 2023

Cardiovasc electrophysiol

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Introduction The benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non‐left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non‐LBBB HF. Methods Consecutive HF patients with non‐LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF‐etiology, and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients. Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) by ≥10%. The primary outcome was the composite of HF‐hospitalizations or all‐cause mortality. Results A total of 96 patients were recruited (mean age 70 ± 11years, 22% female, 68% ischemic HF and 49% AF). Significant reductions in QRS duration and LV dimensions were seen only after CSP, while LVEF improved significantly in both groups (p < 0.05). Echocardiographic response occurred more frequently in CSP than BiV (51% vs. 21%, p < 0.01), with CSP independently associated with four‐fold increased odds (adjusted odds ratio 4.08, 95% confidence interval [CI] 1.34–12.41). The primary outcome occurred more frequently in BiV than CSP (69% vs. 27%, p < 0.001), with CSP independently associated with 58% risk reduction (adjusted hazard ratio [AHR] 0.42, 95% CI 0.21–0.84, p = 0.01), driven by reduced all‐cause mortality (AHR 0.22, 95% CI 0.07–0.68, p < 0.01), and a trend toward reduced HF‐hospitalization (AHR 0.51, 95% CI 0.21–1.21, p = 0.12). Conclusions CSP provided greater electrical synchrony, reverse remodeling, improved cardiac function and survival compared to BiV in non‐LBBB, and may be the preferred CRT strategy for non‐LBBB HF.

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“…In a prospective study from two Singaporean centers following 860 patients with bradycardia, nearly 26% received CSP (95 HBP, 136 LBBAP); those with CSP had a 13% incidence of the primary outcome (composite of heart failure hospitalization, upgrade to BVP, or all-cause mortality), much lower than the 30% of those in the RVP arm. Although limited to only two centers, it was the largest single trial to assess event-free survival in CSP versus RVP across pacemaker dependency levels (RVP >20%) [22 ▪▪ ]. More recently, a meta-analysis of 15 clinical trials across 1,211 patients demonstrated a 20.1ms reduction in QRS duration, a 5.2% increase in LV ejection fraction, and lower NYHA class score in those undergoing CSP compared to BVP [9].…”

Section: Conduction System Pacingmentioning

confidence: 99%

Advances in cardiac pacing with leadless pacemakers and conduction system pacing

Somani,

Rogers

2023

Current Opinion in Cardiology

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Purpose of review The field of cardiac pacing has undergone significant evolution with the introduction and adoption of conduction system pacing (CSP) and leadless pacemakers (LLPMs). These innovations provide benefits over conventional pacing methods including avoiding lead related complications and achieving more physiological cardiac activation. This review critically assesses the latest advancements in CSP and LLPMs, including their benefits, challenges, and potential for future growth. Recent findings CSP, especially of the left bundle branch area, enhances ventricular depolarization and cardiac mechanics. Recent studies show CSP to be favorable over traditional pacing in various patient populations, with an increase in its global adoption. Nevertheless, challenges related to lead placement and long-term maintenance persist. Meanwhile, LLPMs have emerged in response to complications from conventional pacemaker leads. Two main types, Aveir and Micra, have demonstrated improved outcomes and adoption over time. The incorporation of new technologies allows LLPMs to cater to broader patient groups, and their integration with CSP techniques offers exciting potential. Summary The advancements in CSP and LLPMs present a transformative shift in cardiac pacing, with evidence pointing towards enhanced clinical outcomes and reduced complications. Future innovations and research are likely to further elevate the clinical impact of these technologies, ensuring improved patient care for those with conduction system disorders.

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Clinical Outcomes in Conduction System Pacing Compared to Right Ventricular Pacing in Bradycardia

Cited by 12 publications

References 22 publications

Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia

Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block

Advances in cardiac pacing with leadless pacemakers and conduction system pacing

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