Abstract
Objectives: The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP. Background: HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction. Methods: The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization. Results: The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP. Conclusions: NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 766-774 |
| Number of pages | 9 |
| Journal | JACC: Clinical Electrophysiology |
| Volume | 5 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2019 |
| Externally published | Yes |
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Keywords
- heart failure hospitalization
- His bundle pacing
- mortality
- nonselective HBP
- selective HBP
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. / Beer, Dominik; Sharma, Parikshit S.; Subzposh, Faiz A.; Naperkowski, Angela; Pietrasik, Grzegorz M.; Durr, Brendan; Qureshi, M.; Panikkath, Ragesh; Abdelrahman, Mohamed; Williams, Brent A.; Hanifin, Jillian L.; Zimberg, Ryan; Austin, K.; Macuch, Brooke; Trohman, Richard G.; Vanenkevort, Erin A.; Dandamudi, Gopi; Vijayaraman, Pugazhendhi.
In: JACC: Clinical Electrophysiology, Vol. 5, No. 7, 07.2019, p. 766-774.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing
AU - Beer, Dominik
AU - Sharma, Parikshit S.
AU - Subzposh, Faiz A.
AU - Naperkowski, Angela
AU - Pietrasik, Grzegorz M.
AU - Durr, Brendan
AU - Qureshi, M.
AU - Panikkath, Ragesh
AU - Abdelrahman, Mohamed
AU - Williams, Brent A.
AU - Hanifin, Jillian L.
AU - Zimberg, Ryan
AU - Austin, K.
AU - Macuch, Brooke
AU - Trohman, Richard G.
AU - Vanenkevort, Erin A.
AU - Dandamudi, Gopi
AU - Vijayaraman, Pugazhendhi
PY - 2019/7
Y1 - 2019/7
N2 - Objectives: The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP. Background: HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction. Methods: The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization. Results: The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP. Conclusions: NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
AB - Objectives: The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP. Background: HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction. Methods: The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization. Results: The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP. Conclusions: NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
KW - heart failure hospitalization
KW - His bundle pacing
KW - mortality
KW - nonselective HBP
KW - selective HBP
UR - http://www.scopus.com/inward/record.url?scp=85068256903&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068256903&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2019.04.008
DO - 10.1016/j.jacep.2019.04.008
M3 - Article
C2 - 31320004
AN - SCOPUS:85068256903
VL - 5
SP - 766
EP - 774
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
SN - 2405-5018
IS - 7
ER -