Long term clinical outcomes comparison of CSP and RVP in preserved EF patients

Background/Introduction Conduction System Pacing found a role in recent EHRA consensus statements and HRS Pacing Guidelines for patients with a expected high ventricular pacing rate to prevent Pacemaker Induced Cardiopathy, a potential risk even for patient with normal left ventricle systolic function with more than 40% of ventricular pacing rate. Purpose aim of our study is to assess difference in clinical outcome, electrical ventricular activation and left ventricle contractility e synchrony through years between patients receiving CSP pacemaker therapy and patients receiving traditional septal/apical pacing. Methods A total cohort of 101 patients (53 males) with preserved LV systolic function, implanted because of AV disorders, has been enrolled: 51 patients received LBBAP and 52 received RV pacing. Three years after implantation, 62 of these patients (we excluded patient with not relevant ventricular pacing rate and with extensive ischemic cardiopathy) have been evaluated in term of left ventricle synchrony (using Peak Strain Dispersion) and contractility (using Global Longitudinal Strain and EF), QRS duration on ECG, and Quality of Life assessed with KCCQ, with comparison between CSP group and RVP group. Results CSP patients showed significantly narrower QRS (122 ms vs 153 ms of RVP group), leading to significative better LV synchrony with higher mean PSD value (31ms vs 88ms of RVP group, p value <0,001) and significative better LV contractility with lower GLS (-16% vs -11% of RV group, p value <0,001) . We found also a better LV remodeling in CSP patient with significant difference in terms of LV End-diastolic diameter (45 mm vs 49 mm, of RVP group p value 0,002) and volume (83 ml vs 95 ml of RVP group, p value <0,03), with consequent slight difference in EF (60% vs 57,5% of RVP, p value 0,01). No difference have been found in terms of precepted quality of life of hospitalizations, and no difference have been found in terms of electrical parameters and estimated device battery longevity. Conclusion(s) CSP showed to have benefic effects on LV synchrony and systolic function, deserving to be considered as the best options for patients with expected ventricular high-rate percentage, even in preserved EF patients, especially because it looks not to be any cost in terms of battery drainage. Further observation is needed to understand if in the 5 to 10 years interval the better LV functioning could result in significantly better quality of life.