His bundle pacing (alone or with coronary sinus pacing) did not significantly improve death, HF hospitalization, or worsening HF compared to conventional CRT (11% vs 15%, p=0.58).
Case-Control (n=54)
No
Does His bundle pacing (alone or with LV pacing) reduce death or heart failure events compared to conventional CRT in patients with heart failure?
His bundle pacing achieves shorter QRS duration than conventional CRT but does not significantly improve clinical outcomes in this small propensity-matched cohort.
Absolute Event Rate: 11% vs 15%
p-value: p=0.58
BACKGROUND: His bundle pacing (HBP), alone or optimized in association with coronary sinus pacing (HBP+LV) has recently been proposed as an alternative to conventional cardiac resynchronization therapy (CRT). However, there is lack of controlled studies that assessed clinical outcome. METHODS: We did a single-center, propensity-score matched, case-control study of comparison of HBP and HBP+LV versus conventional CRT in patients with heart failure (HF) and standard indications for CRT. The study group patients were consecutively enrolled in the year 2019. The control group patients were selected, by propensity score matching, among those CRT implantations performed in the years 2015-2018. RESULTS: There were 27 patients in each group. In the active group, 12 (44%) patients received HBP alone and 12 (44%) patients HBP+LV pacing. HBP failed in three (11%) patients. In the control group, conventional CRT was achieved in 26 (96%) patients and failed in one. Paced QRS width was shorter in the active than in the control group (128 ± 18 vs. 148 ± 27 ms, p = .004). During a mean of 9.6 months of follow-up, a composite clinical outcome of death, hospitalization for HF or worsening HF occurred in three (11%) in the active group and in four (15%) in the control group, p = .58. No difference was also observed with softer endpoints: NYHA class (1.9 ± 0.7 vs. 2.1 ± 0.7), subjective improvement (74% vs. 74%) and LV ejection fraction (40.7% vs. 40.7%). CONCLUSION: Compared with conventional CRT, a shorter QRS width can be obtained with HBP alone or in association with coronary sinus pacing but we were unable to show a better clinical outcome. There is urgent need for large, randomized trials.
Sénès et al. (Tue,) conducted a case-control in Heart failure (n=54). His bundle pacing (HBP) alone or with coronary sinus pacing (HBP+LV) vs. Conventional cardiac resynchronization therapy (CRT) was evaluated on Composite clinical outcome of death, hospitalization for HF or worsening HF (p=0.58). His bundle pacing (alone or with coronary sinus pacing) did not significantly improve death, HF hospitalization, or worsening HF compared to conventional CRT (11% vs 15%, p=0.58).