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Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease

心脏再同步化治疗 心脏病学 医学 内科学 射血分数 QRS波群 法洛四联症 心力衰竭 心脏病
作者
Jeremy P. Moore,Natasja M.S. de Groot,Matthew O’Connor,Daniel Cortez,Jonathan K. Su,Austin Burrows,Kevin Shannon,Edward T. O’Leary,Maully J. Shah,Paul Khairy,Joseph Atallah,Tom Wong,Michael S. Lloyd,Yannick J.H.J. Taverne,Anne M. Dubin,Jens Cosedis Nielsen,Reinder Evertz,Richard J. Czosek,Malini Madhavan,Philip M. Chang,Alper Aydın,Óscar Cano
出处
期刊:JACC: Clinical Electrophysiology [Elsevier]
卷期号:9 (3): 385-393 被引量:9
标识
DOI:10.1016/j.jacep.2022.10.012
摘要

Dyssynchrony-associated left ventricular systolic dysfunction is a major contributor to heart failure in congenital heart disease (CHD). Although conventional cardiac resynchronization therapy (CRT) has shown benefit, the comparative efficacy of cardiac conduction system pacing (CSP) is unknown.The purpose of this study was compare the clinical outcomes of CSP vs conventional CRT in CHD with biventricular, systemic left ventricular anatomy.Retrospective CSP data from 7 centers were compared with propensity score-matched conventional CRT control subjects. Outcomes were lead performance, change in left ventricular ejection fraction (LVEF), and QRS duration at 12 months.A total of 65 CSP cases were identified (mean age 37 ± 21 years, 46% men). The most common CHDs were tetralogy of Fallot (n = 12 [19%]) and ventricular septal defect (n = 12 [19%]). CSP was achieved after a mean of 2.5 ± 1.6 attempts per procedure (38 patients with left bundle branch pacing, 17 with HBP, 10 with left ventricular septal myocardial). Left bundle branch area pacing [LBBAP] vs HBP was associated with a smaller increase in pacing threshold (Δ pacing threshold 0.2 V vs 0.8 V; P = 0.05) and similar sensing parameters at follow-up. For 25 CSP cases and control subjects with baseline left ventricular systolic dysfunction, improvement in LVEF was non-inferior (Δ LVEF 9.0% vs 6.0%; P = 0.30; 95% confidence limits: -2.9% to 10.0%) and narrowing of QRS duration was more pronounced for CSP (Δ QRS duration 35 ms vs 14 ms; P = 0.04). Complications were similar (3 [12%] CSP, 4 [16%] conventional CRT; P = 1.00).CSP can be reliably achieved in biventricular, systemic left ventricular CHD patients with similar improvement in LVEF and greater QRS narrowing for CSP vs conventional CRT at 1 year. Among CSP patients, pacing electrical parameters were superior for LBBAP vs HBP.
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