Prognostic benefits of His-Purkinje capture in physiological pacemakers for bradycardia.

Autor: Tan ESJ; Department of Cardiology, National University Heart Centre, Singapore, Singapore.; Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore., Soh R; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Lee JY; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Boey E; Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore., Chan SP; Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore., Lim TW; Department of Cardiology, National University Heart Centre, Singapore, Singapore.; Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore., Yeo WT; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Leong KMW; Department of Cardiology, National University Heart Centre, Singapore, Singapore., Seow SC; Department of Cardiology, National University Heart Centre, Singapore, Singapore.; Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore., Kojodjojo P; Department of Cardiology, National University Heart Centre, Singapore, Singapore.; Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.; Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2024 Apr; Vol. 35 (4), pp. 727-736. Date of Electronic Publication: 2024 Feb 13.
DOI: 10.1111/jce.16211
Abstrakt: 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% (p interaction  < .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.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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