Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block
Key result
His-Purkinje conduction system pacing yields similar echocardiographic response to biventricular pacing in ventricular dysfunction.
- OR 0.50
- 95% CI 0.13-2.00
- P=0.33
- n=50
Why the study?
It was unknown whether His-Purkinje conduction system pacing could be an alternative to BiVCRT in patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block.
Does His-Purkinje conduction system pacing improve echocardiographic response and clinical outcomes compared to biventricular pacing in patients with left ventricular dysfunction and AV block?
Population
Patients with left ventricular dysfunction and AV block
Comparison
HPCSP vs BiVCRT
Design
1:1 matched comparative cohort study
Follow-up
6-month
Authors
Discussion
Loading...
Member takes
Implication
Comparable response rates do not support practice change; leaves open need for RCTs of His-Purkinje pacing.
Study Design
Type
Observational (n=50)
Multicenter
No
Structured PICO
Does His-Purkinje conduction system pacing improve echocardiographic response and clinical outcomes compared to biventricular pacing in patients with left ventricular dysfunction and AV block?
P
Population
Patients with left ventricular dysfunction (LVEF ≤45%) needing ventricular pacing due to atrioventricular block (n=50 analyzed).
I
Intervention
His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing
C
Comparator
Biventricular cardiac resynchronization therapy (BiVCRT) from a historical cohort, 1:1 matched by age, LVEF, atrial fibrillation, renal function, and cardiomyopathy type
O
Outcome
Responder rate (defined as survival, no requirement for heart transplantation, and LVEF increase ≥5 points) at 6-month follow-upcomposite
Main Result
Effect estimate: OR 0.50 (95% CI 0.13-2.00)
Absolute Event Rate: 76% vs 64%
p-value: p=0.33
His-Purkinje conduction system pacing provides a comparable echocardiographic response to biventricular pacing, with potentially superior improvements in mitral regurgitation and NYHA functional class for patients with LV dysfunction and AV block.
Limitations
- Compared a prospective cohort with a historical cohort
- Cohorts were not contemporaries, meaning evolution in medical treatment and BiVCRT implants could affect results
- Small sample size
- Non-randomized design
Cite This Study
Pujol‐López et al. (2022) conducted an observational in Ventricular dysfunction and atrioventricular block (n=50). His-Purkinje conduction system pacing (HPCSP) vs. Biventricular cardiac resynchronization therapy (BiVCRT) was evaluated on Echocardiographic response (survival without heart transplantation and LVEF increase ≥5 points) (OR 0.50, 95% CI 0.13-2.00, p=0.33). His-Purkinje conduction system pacing resulted in a similar echocardiographic response rate compared to biventricular pacing (76% vs 64%, p=0.33) in patients with ventricular dysfunction and AV block.