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
N1 - Funding Information:
Dr. Sharma has received speaking honoraria from Medtronic; and consulting honoraria from Medtronic, Abbott, and Biotronik. Dr. Subzposh has received speaking honoraria from Medtronic. Dr. Trohman has served on the advisory board of Boston Scientific/Guidant; has received research grants from Boston Scientific/Guidant, Medtronic, St. Jude Medical (Abbott), Vitatron, and Wyeth-Ayerst/Wyeth Pharmaceuticals; has received consulting honoraria from Biosense Webster, St. Jude Medical (Abbott), and AltaThera Pharmaceuticals; has received speaking or other honoraria from Boston Scientific/Guidant, Medtronic, Daiichi Sankyo, AltaThera Pharmaceuticals, and St. Jude Medical (Abbott). Dr. Dandamundi has received speaking and consulting honoraria and research funding from Medtronic. Dr. Vijayaraman has received speaking honoraria and research funding from Medtronic; has received consulting honoraria from Medtronic, Boston Scientific, Abbott, and Biotronik; and has a patent pending for a His delivery tool. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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 - His bundle pacing
KW - heart failure hospitalization
KW - mortality
KW - nonselective HBP
KW - selective HBP
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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 -