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González-Matos CE, Rodríguez-Queralto O, Záraket F, Jiménez J, Casteigt B, Vallès E. Conduction System Stimulation to Avoid Left Ventricle Dysfunction. Circ Arrhythm Electrophysiol 2024; 17:e012473. [PMID: 38284238 DOI: 10.1161/circep.123.012473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Right ventricular apical pacing (RVAP) can produce left ventricle dysfunction. Conduction system pacing (CSP) has been used successfully to reverse left ventricle dysfunction in patients with left bundle branch block. To date, data about CSP prevention of left ventricle dysfunction in patients with preserved left ventricular ejection fraction (LVEF) are scarce and limited mostly to nonrandomized studies. Our aim is to demonstrate that CSP can preserve normal ventricular function compared with RVAP in the setting of a high burden of ventricular pacing. METHODS Consecutive patients with a high-degree atrioventricular block and preserved or mildly deteriorated LVEF (>40%) were included in this prospective, randomized, parallel, controlled study, comparing conventional RVAP versus CSP. RESULTS Seventy-five patients were randomized, with no differences between basal characteristics in both groups. The stimulated QRS duration was significantly longer in the RVAP group compared with the CSP group (160.4±18.1 versus 124.2±20.2 ms; p<0.01). Seventy patients were included in the intention-to-treat analyses. LVEF showed a significant decrease in the RVAP group at 6 months compared with the CSP group (mean difference, -5.8% [95% CI, -9.6% to -2%]; P<0.01). Left ventricular end-diastolic diameter showed an increase in the RVAP group compared with the CSP group (mean difference, 3.2 [95% CI, 0.1-6.2] mm; P=0.04). Heart failure-related admissions were higher in the RVAP group (22.6% versus 5.1%; P=0.03). CONCLUSIONS Conduction system stimulation prevents LVEF deterioration and heart failure-related admissions in patients with normal or mildly deteriorated LVEF requiring a high burden of ventricular pacing. These results are only short term and need to be confirmed by further larger studies. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT06026683.
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Affiliation(s)
- Carlos E González-Matos
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
| | - Oriol Rodríguez-Queralto
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Fátima Záraket
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Jesús Jiménez
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Benjamín Casteigt
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
| | - Ermengol Vallès
- Electrophysiology Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain (C.E.G.-M., E.V.)
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (C.E.G.-M., O.R.-Q., F.Z., J.J., B.C., E.V.)
- Universitat Pompeu Fabra, Barcelona, Spain (C.E.G.-M., E.V.)
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Thibault B, Mondésert B, Dubuc M, Venier S, Palazzolo J, Casteigt B, Ascoeta S, Dyrda K, Guerra P, Khairy P, Rivard L, Roy D, Talajic M, Macle L. IT IS POSSIBLE TO REDUCE EXPOSURE TO IONIZING RADIATION BY > 90% DURING CARDIAC RESYNCHRONIZATION THERAPY IMPLANT PROCEDURES IN THE EP LAB: THE MONTRÉAL HEART INSTITUTE EXPERIENCE WITH LOW-DOSE FLUOROSCOPY SETTINGS AND MEDIGUIDE. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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