What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with mildly reduced ejection fraction (HFmrEF) and high percentage of ventricular pacing (n=66). Intervention: Conduction system pacing (CSP) vs. Baseline (pre-procedure). Primary outcome: Left ventricular ejection fraction (LVEF) (p=<0.001).

May 16, 2023Open Access

Conduction system pacing improves the outcomes on patients with high percentage of ventricular pacing and heart failure with mildly reduced ejection fraction

Q: What are the key findings of this study?

Conduction system pacing significantly improved left ventricular ejection fraction from 42.45% to 49.97% and reduced left ventricular end-diastolic diameter in patients with HFmrEF.

Key Result

Conduction system pacing significantly improved left ventricular ejection fraction from 42.45% to 49.97% and reduced left ventricular end-diastolic diameter in patients with HFmrEF.

Study Design

Type

Observational (n=66)

Multicenter

Structured PICO

Does conduction system pacing improve cardiac function and reverse remodeling in patients with HFmrEF and a high percentage of ventricular pacing?

Population

66 patients with heart failure with mildly reduced ejection fraction and ventricular pacing >40% who underwent conduction system pacing, followed for a mean of 23.1 months.

Intervention

Conduction system pacing (CSP), including His bundle pacing (HBP) or left bundle branch pacing (LBBP).

Outcome

Changes in cardiac performance (LVEF, LVEDD, LAD, NYHA classification) before and after the procedure at mean 23.12 months follow-up.surrogate

Conduction system pacing, particularly left bundle branch pacing, is feasible, safe, and significantly improves left ventricular function and reverses remodeling in patients with HFmrEF requiring a high percentage of ventricular pacing.

Main Result

Absolute Event Rate: 49.97% vs 42.45%

p-value: p=<0.001

Limitations

Lack of a randomized controlled trial design to directly compare CSP to biventricular pacing
Small sample size requiring further confirmation in larger trials

Abstract

Aims This study aimed to investigate the efficacy and safety of CSP in patients with a high percentage of ventricular pacing and heart failure with HFmrEF. Methods Patients who underwent CSP for HFmrEF and ventricular pacing 40% were consecutively enrolled from January 2018 to May 2021. All participants were followed up at least 12 months. Clinical data including cardiac performance and lead outcomes were compared before and after the procedure. Left ventricular ejection fraction (LVEF) was measured using the biplane Simpson's method. HFmrEF was defined as heart failure with the LVEF ranging from 41%–49%. Results CSP was successfully performed in 64 cases (96.97%), which included 16 cases of left bundle branch pacing (LBBP) and 48 cases of His bundle pacing (HBP). After a mean of 23.12 ± 8.17 months follow-up, NYHA classification ( P 0.001), LVEF (42.45 ± 1.84% vs. 49.97 ± 3.57%, P 0.001) and left ventricular end diastolic diameter (LVEDD) (55.59 ± 6.17 mm vs. 51.66 ± 3.48 mm, P 0.001) improved significantly. During follow-up, more than half (39/64,60.9%) of patients returned to normal LVEF and LVEDD with complete reverse remodeling. The pacing threshold in LBBP was lower (0.90 ± 0.27 V@0.4 ms vs. 1.61 ± 0.71 V@0.4 ms, P 0.001) than that in HBP. No perforation, electrode dislodging, thrombosis or infection was observed during follow-up. Conclusions CSP could improve the clinical outcomes in patients with HFmrEF and a high percentage of ventricular pacing. LBBP might be a better choice because of its feasibility and safety, especially in patients with infranodal atrioventricular block.

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