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Pujol‐López M, Jiménez Arjona R, Guasch E, Borràs R, Doltra A, Vázquez‐Calvo S, Roca‐Luque I, Garre P, Ferró E, Niebla M, Carro E, Puente JL, Uribe L, Invers E, Castel MÁ, Arbelo E, Sitges M, Mont L, Tolosana JM. Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block. Pacing Clin Electrophysiol 2022; 45:1115-1123. [PMID: 35583311 PMCID: PMC9796875 DOI: 10.1111/pace.14535] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/11/2022] [Accepted: 05/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT. METHODS Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up. RESULTS HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02). CONCLUSION HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
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Affiliation(s)
- Margarida Pujol‐López
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Rafael Jiménez Arjona
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Eduard Guasch
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos IIIMadridSpain
| | - Adelina Doltra
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Sara Vázquez‐Calvo
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Ivo Roca‐Luque
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Paz Garre
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | | | - Mireia Niebla
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Esther Carro
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Jose L. Puente
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Laura Uribe
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Eric Invers
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Maria Ángeles Castel
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Elena Arbelo
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Marta Sitges
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - José M. Tolosana
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
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