Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing

Dominik Beer, Parikshit S. Sharma, Faiz A. Subzposh, Angela Naperkowski, Grzegorz M. Pietrasik, Brendan Durr, M. Qureshi, Ragesh Panikkath, Mohamed Abdelrahman, Brent A. Williams, Jillian L. Hanifin, Ryan Zimberg, K. Austin, Brooke Macuch, Richard G. Trohman, Erin A. Vanenkevort, Gopi Dandamudi, Pugazhendhi Vijayaraman

Research output: Contribution to journalArticle

3 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)766-774
Number of pages9
JournalJACC: Clinical Electrophysiology
Volume5
Issue number7
DOIs
StatePublished - Jul 2019
Externally publishedYes

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Bundle of His
Hospitalization
Heart Failure

Keywords

  • heart failure hospitalization
  • His bundle pacing
  • mortality
  • nonselective HBP
  • selective HBP

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Beer, D., Sharma, P. S., Subzposh, F. A., Naperkowski, A., Pietrasik, G. M., Durr, B., ... Vijayaraman, P. (2019). Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. JACC: Clinical Electrophysiology, 5(7), 766-774. https://doi.org/10.1016/j.jacep.2019.04.008

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 journalArticle

Beer, D, Sharma, PS, Subzposh, FA, Naperkowski, A, Pietrasik, GM, Durr, B, Qureshi, M, Panikkath, R, Abdelrahman, M, Williams, BA, Hanifin, JL, Zimberg, R, Austin, K, Macuch, B, Trohman, RG, Vanenkevort, EA, Dandamudi, G & Vijayaraman, P 2019, 'Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing', JACC: Clinical Electrophysiology, vol. 5, no. 7, pp. 766-774. https://doi.org/10.1016/j.jacep.2019.04.008
Beer D, Sharma PS, Subzposh FA, Naperkowski A, Pietrasik GM, Durr B et al. Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. JACC: Clinical Electrophysiology. 2019 Jul;5(7):766-774. https://doi.org/10.1016/j.jacep.2019.04.008
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. / Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. In: JACC: Clinical Electrophysiology. 2019 ; Vol. 5, No. 7. pp. 766-774.
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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

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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

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