Prognostic benefits of His‐Purkinje capture in physiological pacemakers for bradycardia

• Published in: Journal of cardiovascular electrophysiology Vol. 35; no. 4; pp. 727 - 736
• Main Authors: Tan, Eugene S. J., Soh, Rodney, Lee, Jie‐Ying, Boey, Elaine, Chan, Siew‐Pang, Lim, Toon Wei, Yeo, Wee Tiong, Leong, Kevin M. W., Seow, Swee‐Chong, Kojodjojo, Pipin
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2024
• Subjects: Aged; Aged, 80 and over; Bradycardia; Bradycardia - diagnosis; Bradycardia - etiology; Bradycardia - therapy; Bundle of His; Cardiac arrhythmia; Cardiac Conduction System Disease; Cardiac Pacing, Artificial - adverse effects; Clinical outcomes; Conduction; conduction system pacing; Congestive heart failure; Electrocardiography; Female; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - therapy; His‐bundle pacing; His‐Purkinje capture; Hospitalization; Humans; left bundle branch pacing; Male; Middle Aged; Mortality; Pacemaker, Artificial; Prognosis; Risk factors; Treatment Outcome; Ventricle; ventricular septal pacing; conduction system pacing; His‐bundle pacing; His‐Purkinje capture; ventricular septal pacing; bradycardia; left bundle branch pacing
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16211

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.