Key result
Conduction system pacing preserves S-ICD eligibility comparable to sinus rhythm, achieving ~87% pass rates.
Why the study?
Pre-implantation screening prevents inappropriate sensing in S-ICD patients, but the impact of paced QRS-T morphology and different pacing sites on screening outcomes remained to be explored.
Does the site of ventricular pacing affect S-ICD eligibility during pre-implantation screening compared to intrinsic sinus rhythm?
Cross-Sectional (n=30)
No
Does the site of ventricular pacing affect S-ICD eligibility during pre-implantation screening compared to intrinsic sinus rhythm?
p-value: p=<0.001
Conduction system pacing preserves S-ICD screening eligibility comparable to sinus rhythm, whereas right ventricular pacing significantly impairs sensing performance.
Should not yet alter pacing strategy for S-ICD candidates; leaves open prospective validation of site-specific screening effects.
BACKGROUND: Pre-implantation screening is a crucial step in preventing inappropriate sensing in patients with subcutaneous implantable cardioverter defibrillators (S-ICDs). Paced QRS-T morphology may influence screening outcomes. We aimed to explore the impact of pacing rhythm and different pacing sites on pre-implantation screening of S-ICD. METHODS AND RESULTS: This prospective, single-center study enrolled patients referred for radiofrequency ablation, with both left and right-heart access. A contact-force ablation catheter was used to mimic ventricular pacing at different sites. Automatic screening tests for S-ICD eligibility were performed during pacing and sinus rhythm. The impact of pacing sites on S-ICD eligibility was assessed. Thirty patients (age 54.0 ± 15.0 years, 73.3% male) were enrolled. The overall passing rate during intrinsic sinus rhythm was 86.7%. Compared with sinus rhythm, conduction system pacing from His bundle or left bundle branch demonstrated comparable pass rates and the number of passed vectors, whereas right ventricular septum (RVS) pacing exhibited significantly lower pass rates and less pass vectors. Among all RVS pacing sites, the lowest pass rate was observed at the apical portion, followed by middle and basal portion (p < 0.001 for all comparisons). CONCLUSION: Conduction system pacing preserves patient eligibility for S-ICD comparable to sinus rhythm, while RVS pacing significantly impairs sensing performance, with the greatest deterioration observed in apical pacing. These findings underscore the advantages of conduction system pacing in optimizing sensing function for patients eligible for both S-ICDs and pacemakers.
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Shen et al. (2025) conducted a cross-sectional in Patients referred for radiofrequency ablation (n=30). Ventricular pacing at different sites (conduction system vs right ventricular septum) vs. Intrinsic sinus rhythm was evaluated on S-ICD eligibility pass rate (p=<0.001). Conduction system pacing preserved S-ICD eligibility comparable to intrinsic sinus rhythm (86.7% pass rate), while right ventricular septum pacing significantly impaired sensing performance.
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