Prognostic benefits of His-Purkinje capture in physiological pacemakers for bradycardia.
J Cardiovasc Electrophysiol
; 35(4): 727-736, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-38351331
ABSTRACT
INTRODUCTION:
Clinical outcomes of long-term ventricular septal pacing (VSP) without His-Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP).METHODS:
Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)-hospitalizations and all-cause mortality at 2 years. VSP was defined as septal pacing due to unsuccessful CSP implant or successful CSP followed by loss of His-Purkinje capture within 90 days.RESULTS:
Among 1016 patients (age 73.9 ± 11.2 years, 47% female, 48% atrioventricular block), 612 received RVP, 335 received CSP and 69 received VSP. Paced QRS duration was similar between VSP and RVP, but both significantly longer than CSP (p < .05). HF-hospitalizations occurred in 130 (13%) patients (CSP 7% vs. RVP 16% vs. VSP 13%, p = .001), and all-cause mortality in 143 (14%) patients (CSP 7% vs. RVP 19% vs. VSP 9%, p < .001). The association of pacing modality with clinical events was limited to those with ventricular pacing (Vp) > 20% (pinteraction < .05). Adjusting for clinical risk factors among patients with Vp > 20%, VSP (adjusted hazard ratio [AHR] 4.74, 95% confidence interval [CI] 1.57-14.36) and RVP (AHR 3.08, 95% CI 1.44-6.60) were associated with increased hazard of HF-hospitalizations, and RVP (2.52, 95% CI 1.19-5.35) with increased mortality, compared to CSP. Clinical endpoints did not differ between VSP and RVP with Vp > 20%, or amongst groups with Vp < 20%.CONCLUSION:
Conduction system capture is associated with improved clinical outcomes. CSP should be preferred over VSP or RVP during pacing for bradycardia.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pacemaker, Artificial
/
Heart Failure
Type of study:
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Cardiovasc Electrophysiol
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
FISIOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: