Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

Zhang, Duoduo; Zhao, Fangyuan; Yang, Yanzong; Ma, Chengming; Ma, Peipei; Zhao, Yu; Xia, Yunlong; Gao, Lianjun; Dong, Yan

doi:10.3389/fcvm.2023.1132520

Front. Cardiovasc. Med.

2023

DOI: 10.3389/fcvm.2023.1132520

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Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

Duoduo Zhang

Fangyuan Zhao

Yanzong Yang

et al.

Abstract: AimsThis study aimed to investigate the efficacy and safety of CSP in patients with a high percentage of ventricular pacing and heart failure with HFmrEF.MethodsPatients who underwent CSP for HFmrEF and ventricular pacing >40% were consecutively enrolled from January 2018 to May 2021. All participants were followed up at least 12 months. Clinical data including cardiac performance and lead outcomes were compared before and after the procedure. Left ventricular ejection fraction (LVEF) was measured using… Show more

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2024

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Cited by 2 publications

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Is conduction system pacing more effective than right ventricular pacing in reducing atrial high-rate episodes in patients with heart failure and preserved ejection fraction?

Chen,

Ma,

Liu

et al. 2024

Front. Physiol.

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BackgroundThe relationship between conduction system pacing (CSP) and the incidence of atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF) remains uncertain. This study aims to investigate the occurrence of atrial high-rate episodes (AHREs) following CSP in patients with HFpEF, in comparison to right ventricular pacing (RVP).MethodsPatients with HFpEF who received dual-chamber pacemakers for atrioventricular block were retrospectively enrolled from January 2018 to January 2023. Both new-onset and progressive AHREs were recorded, along with other clinical data, including cardiac performance and lead outcomes.ResultsA total of 498 patients were enrolled, comprising 387 patients with RVP and 111 patients with CSP, with a follow-up duration of 44.42 ± 10.41 months. In patients without a prior history of AF, CSP was associated with a significantly lower incidence of new-onset AHREs when the percentage of ventricular pacing was ≥20% (9.52% vs. 29.70%, P = 0.001). After adjusting for confounding factors, CSP exhibited a lower hazard ratio for new-onset AHREs compared to RVP (HR 0.336; [95% CI: 0.142–0.795]; P = 0.013), alongside left atrial diameter (LAD) (HR 1.109; [95% CI: 1.048–1.173]; P < 0.001). In patients with a history of AF, the progression of AHREs in CSP and RVP did not differ significantly (32.35% vs. 34.75%, P = 0.791). Cardiac performance metrics, including left ventricular end-diastolic diameter (LVEDD) (49.09 ± 4.28 mm vs. 48.08 ± 4.72 mm; P = 0.015), LAD (40.68 ± 5.49 mm vs. 39.47 ± 5.24 mm; P = 0.001), and NYHA class (2.31 ± 0.46 vs. 1.59 ± 0.73; P < 0.001), improved obviously following CSP, while LVEDD (48.37 ± 4.57 mm vs. 49.30 ± 5.32 mm; P < 0.001), LAD (39.77 ± 4.58 mm vs. 40.83 ± 4.80 mm; P < 0.001), NYHA class (2.24 ± 0.43 vs. 2.35 ± 0.83; P = 0.018), and left ventricular ejection fraction (LVEF) (57.41 ± 2.42 vs. 54.24 ± 6.65; P < 0.001) deteriorated after RVP.ConclusionOur findings suggest that CSP may be associated with improvements in cardiac performance and a reduction in new-onset AHREs compared to RVP in patients with HFpEF. However, prospective randomized trials are anticipated to confirm these potential benefits.

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Is conduction system pacing more effective than right ventricular pacing in reducing atrial high-rate episodes in patients with heart failure and preserved ejection fraction?

Chen,

Ma,

Liu

et al. 2024

Front. Physiol.

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Mid-Term Impact of Conduction System Pacing on Overall Cardiac Performance: A Non-Randomized, Prospective, Single-Center Echocardiographic Study

Pestrea,

Cicala,

Enache

et al. 2024

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Introduction. Recently published data suggested significantly lower pacing-induced cardiomyopathy (PICM) incidence with conduction system pacing (CSP). Because most data evaluated only the impact on the left ventricle, this study aimed to assess changes in echocardiographic parameters of morphology and function for all heart chambers in patients with baseline preserved and mid-range LVEF over a medium-term follow-up period after CSP. Methods. A total of 128 consecutive patients with LVEF > 40% and successful CSP for bradyarrhythmic indication were prospectively enrolled. A complete 2D echocardiographic examination was performed at baseline and the last follow-up. Results. In total, 38 patients received His bundle pacing (HBP) and 90 received left bundle branch area pacing (LBBAP). The mean follow-up period was 699.2 ± 177.2 days, with 23 patients lost during this period. The ventricular pacing burden for the entire group was 97.2 ± 4.2%. Only three patients (2.9%) met the criteria for PICM. CSP led to a significant increase in LVEF (from 54.2 ± 7.9 to 56.7 ± 7.8%, p = 0.01) and a significant decrease in LV diastolic (from 107.2 ± 41.8 to 91.3 ± 41.8 mL, p < 0.001) and systolic (from 49.7 ± 21.4 to 39.5 ± 18.2 mL, p < 0.001) volumes. There were no significant changes in E/e′, mitral regurgitation, atrial volumes, and right ventricle (RV) diameter. There was a significant improvement in RV function. Tricuspid regurgitation was the only parameter that worsened. There were no differences in evolution for each echocardiographic parameter between the HBP and the LBBAP groups. Conclusions. HBP and LBBAP are equally protective for harmful changes in both atria and ventricles. The prevalence of PICM, defined as a decrease in LVEF, is very low with CSP.

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Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

Cited by 2 publications

References 35 publications

Is conduction system pacing more effective than right ventricular pacing in reducing atrial high-rate episodes in patients with heart failure and preserved ejection fraction?

Is conduction system pacing more effective than right ventricular pacing in reducing atrial high-rate episodes in patients with heart failure and preserved ejection fraction?

Mid-Term Impact of Conduction System Pacing on Overall Cardiac Performance: A Non-Randomized, Prospective, Single-Center Echocardiographic Study

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