Cardiac conduction system pacing was non-inferior to conventional CRT for improving LVEF in congenital heart disease patients (Δ 9.0% vs 6.0%; 95% CI -2.9 to 10.0%; P=0.30).
Cohort
Yes
Does cardiac conduction system pacing improve LVEF and QRS duration compared to conventional CRT in patients with congenital heart disease?
Conduction system pacing is a feasible alternative to conventional CRT in congenital heart disease patients, offering similar LVEF improvement and superior QRS narrowing.
Absolute Event Rate: 9% vs 6%
p-value: p=0.30
BACKGROUND: Dyssynchrony-associated left ventricular systolic dysfunction is a major contributor to heart failure in congenital heart disease (CHD). Although conventional cardiac resynchronization therapy (CRT) has shown benefit, the comparative efficacy of cardiac conduction system pacing (CSP) is unknown. OBJECTIVES: The purpose of this study was compare the clinical outcomes of CSP vs conventional CRT in CHD with biventricular, systemic left ventricular anatomy. METHODS: Retrospective CSP data from 7 centers were compared with propensity score-matched conventional CRT control subjects. Outcomes were lead performance, change in left ventricular ejection fraction (LVEF), and QRS duration at 12 months. RESULTS: A total of 65 CSP cases were identified (mean age 37 ± 21 years, 46% men). The most common CHDs were tetralogy of Fallot (n = 12 19%) and ventricular septal defect (n = 12 19%). CSP was achieved after a mean of 2.5 ± 1.6 attempts per procedure (38 patients with left bundle branch pacing, 17 with HBP, 10 with left ventricular septal myocardial). Left bundle branch area pacing LBBAP vs HBP was associated with a smaller increase in pacing threshold (Δ pacing threshold 0.2 V vs 0.8 V; P = 0.05) and similar sensing parameters at follow-up. For 25 CSP cases and control subjects with baseline left ventricular systolic dysfunction, improvement in LVEF was non-inferior (Δ LVEF 9.0% vs 6.0%; P = 0.30; 95% confidence limits: -2.9% to 10.0%) and narrowing of QRS duration was more pronounced for CSP (Δ QRS duration 35 ms vs 14 ms; P = 0.04). Complications were similar (3 12% CSP, 4 16% conventional CRT; P = 1.00). CONCLUSIONS: CSP can be reliably achieved in biventricular, systemic left ventricular CHD patients with similar improvement in LVEF and greater QRS narrowing for CSP vs conventional CRT at 1 year. Among CSP patients, pacing electrical parameters were superior for LBBAP vs HBP.
Moore et al. (Wed,) conducted a cohort in Congenital heart disease with biventricular, systemic left ventricular anatomy. Cardiac conduction system pacing (CSP) vs. Conventional cardiac resynchronization therapy (CRT) was evaluated on Change in left ventricular ejection fraction (LVEF) at 12 months (95% CI -2.9 to 10.0, p=0.30). Cardiac conduction system pacing was non-inferior to conventional CRT for improving LVEF in congenital heart disease patients (Δ 9.0% vs 6.0%; 95% CI -2.9 to 10.0%; P=0.30).