Is His‐optimized superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a propensity‐matched study

Autor:	Daniele Oddone, Michele Brignole, Nicola Bottoni, Teresa Grimaldi, Enrico Puggioni, Jacopo Senes, Giuseppe Mascia, Iacopo Bertolozzi, Paolo Donateo, Calogero Minneci, Giovanni Coluccia
Rok vydání:	2021
Předmět:	Male Bundle of His medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy Nyha class law.invention Cardiac Resynchronization Therapy Randomized controlled trial law Internal medicine medicine Humans In patient Propensity Score Coronary sinus Aged Heart Failure Ejection fraction business.industry General Medicine medicine.disease Case-Control Studies Heart failure Propensity score matching Cardiology Female Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 44:1532-1539
ISSN:	1540-8159 0147-8389
Popis:	Background His bundle pacing (HBP), alone or optimized in association with coronary sinus pacing (HBP+LV) has recently been proposed as an alternative to conventional cardiac resynchronization therapy (CRT). However, there is lack of controlled studies that assessed clinical outcome. Methods We did a single-center, propensity-score matched, case-control study of comparison of HBP and HBP+LV versus conventional CRT in patients with heart failure (HF) and standard indications for CRT. The study group patients were consecutively enrolled in the year 2019. The control group patients were selected, by propensity score matching, among those CRT implantations performed in the years 2015-2018. Results There were 27 patients in each group. In the active group, 12 (44%) patients received HBP alone and 12 (44%) patients HBP+LV pacing. HBP failed in three (11%) patients. In the control group, conventional CRT was achieved in 26 (96%) patients and failed in one. Paced QRS width was shorter in the active than in the control group (128 ± 18 vs. 148 ± 27 ms, p = .004). During a mean of 9.6 months of follow-up, a composite clinical outcome of death, hospitalization for HF or worsening HF occurred in three (11%) in the active group and in four (15%) in the control group, p = .58. No difference was also observed with softer endpoints: NYHA class (1.9 ± 0.7 vs. 2.1 ± 0.7), subjective improvement (74% vs. 74%) and LV ejection fraction (40.7% vs. 40.7%). Conclusion Compared with conventional CRT, a shorter QRS width can be obtained with HBP alone or in association with coronary sinus pacing but we were unable to show a better clinical outcome. There is urgent need for large, randomized trials.
Databáze:	OpenAIRE
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