Language

English

Publication Date

6-1-2025

Journal

Heart Rhythm

DOI

10.1016/j.hrthm.2024.09.030

PMID

39343119

PMCID

PMC13234861

PubMedCentral® Posted Date

6-5-2026

PubMedCentral® Full Text Version

Author MSS

Abstract

Background: Cardiac resynchronization therapy (CRT) is a guideline-recommended therapy in patients with heart failure with mildly reduced ejection fraction (HFmrEF, 36%-50%) and left bundle branch block or indication for ventricular pacing. Conduction system pacing (CSP) using left bundle branch area pacing or His bundle pacing has been shown to be a safe and physiologic alternative to biventricular pacing (BVP).

Objective: The aim of this study was to compare the clinical outcomes between BVP and CSP for patients with HFmrEF undergoing CRT.

Methods: Consecutive patients who underwent BVP or CSP with HFmrEF between January 2018 and June 2023 at 16 international centers were included. The primary outcome was the composite end point of time to death or heart failure hospitalization (HFH). Secondary end points included change in left ventricular ejection fraction (LVEF) and individual end points of death and HFH.

Results: A total of 1004 patients met inclusion criteria: BVP, 178; CSP, 826 (His bundle pacing, 154; left bundle branch area pacing, 672). Mean age was 73 ± 13 years; female, 34%; and LVEF, 42% ± 5%. Paced QRS duration in CSP was significantly narrower compared with BVP (129 ± 21 ms vs 144 ± 19 ms; P < .001). LVEF improved during follow-up in both groups (49% ± 10% vs 48% ± 10%; P = .32). CSP was independently associated with significant reduction in the primary end point of time to death or HFH compared with BVP (22% vs 34%; hazard ratio, 0.64; 95% confidence interval, 0.43-0.94; P = .025).

Conclusion: CSP was associated with improved clinical outcomes compared with BVP in this large cohort of patients with HFmrEF undergoing CRT. Randomized controlled trials comparing CSP with BVP will be necessary to confirm these results.

Keywords

Aged, Female, Humans, Male, Bundle of His, Bundle-Branch Block, Cardiac Resynchronization Therapy, Follow-Up Studies, Heart Conduction System, Heart Failure, Retrospective Studies, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Case-Control Studies, Biventricular pacing, Cardiac resynchronization therapy, Conduction system pacing, His bundle pacing, Left bundle branch area pacing, HFmrEF, Heart failure hospitalization, Mortality

Published Open-Access

yes

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