Safety and Feasibility of His-Purkinje System Pacing for Over 85-year-old Patients with Symptomatic Bradycardia: A Comparative Study with A Younger Cohort.

Introduction: His-Purkinje system (HPS) pacing emerges as an ideal strategy to restore cardiac synchrony. However, there is insufficient evidence to confirm the safety of HPS pacing in advanced age patients who are vulnerable to invasive procedures. Methods: We aimed to evaluate the short-term feasibility and safety of HPS pacing in symptomatic bradycardia patients over 85 years of age by comparing the pacing parameters and clinical outcomes with a younger cohort. 189 out of 198 consecutive patients underwent HPS pacing with symptomatic bradycardia were included. Among them 37 and 152 were aged over 85 years and below 85 years respectively. Peri- and post-procedure pacing parameters, cardiac function and clinical events were thoroughly evaluated during follow-up. Results: Compared with the younger cohort, the elderly had worse renal function and cardiac function. All 189 patients underwent successful HPS pacing, among whom 28 were paced at His-bundle. Paced QRS duration was shortened non-significantly compared with intrinsic, which showed no difference between cohorts. Pacing threshold and impedance decreased significantly without difference between cohorts. Lead dislodgement and pocket hematoma/infection only occurred in 2 (1.3%) and 4 (0.7%) younger patients, respectively. Through a 10.5±3.0 months follow-up, A non-significant improvement in cardiac function was indicated by echocardiographic indices. Clinical events incidences were comparable, except a higher incidence of myocardial infarction (8.1% vs 0.7%) observed in the advanced age cohort. Conclusion: Compared with the younger, HPS pacing could safely restore physiological conduction and reserve cardiac function in advanced age patients with symptomatic bradycardia.