Geisinger Wyoming Valley Medical Center, Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA.
Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2022 Jun;33(6):1234-1243. doi: 10.1111/jce.15516. Epub 2022 May 10.
His bundle pacing (HBP) is the most physiologic form of pacing and has been associated with reduced risk for heart failure hospitalization (HFH) and mortality compared to right ventricular pacing. Left bundle branch area pacing (LBBAP) is a safe and effective alternative option for patients needing ventricular pacing. The aim of this study was to compare the clinical outcomes between LBBAP and HBP among a large cohort of patients undergoing permanent pacemaker implantation.
This observational registry included consecutive patients with AV block/AV node ablation who underwent de novo permanent pacemaker implantations with successful LBBAP or HBP between April 2018 and October 2020. The primary outcome was the composite endpoint of time to death from any cause or HFH. Secondary outcomes included the composite endpoint among patients with prespecified ventricular pacing burden and individual outcomes.
The study population included 359 patients who met the inclusion criteria (163 in the HBP and 196 in the LBBAP group). Paced QRSd during LBBAP was similar to HBP (125 ± 20.2 vs. 126 ± 23.5 ms, p = .643). There were no statistically significant differences in the primary composite outcome in LBBAP (17.3%) compared to HBP (24.5%) (hazard ratio [HR]: 1.15, 95% CI: 0.72-1.82, p = .552). Secondary outcomes of death (10% vs. 17%; HR: 1.3, 95% CI: 0.73-2.33, p = .38) and HFH (10% vs. 12%; HR: 1.02, 95% CI: 0.54-1.94, p = .94) were not different among both groups.
There were no statistically significant differences in the clinical outcomes of death or HFH in LBBAP when compared to HBP.
希氏束起搏（HBP）是最生理性的起搏方式，与右心室起搏相比，其与心力衰竭住院（HFH）和死亡率降低相关。左束支区域起搏（LBBAP）是一种安全有效的替代选择，适用于需要心室起搏的患者。本研究的目的是比较在接受永久性起搏器植入的大量患者中，LBBAP 与 HBP 的临床结果。
本观察性注册研究纳入了 2018 年 4 月至 2020 年 10 月期间因房室阻滞/房室结消融而行首次永久性起搏器植入并成功进行 LBBAP 或 HBP 的连续患者。主要终点是由任何原因引起的死亡或 HFH 的复合终点。次要终点包括在有特定心室起搏负担的患者中的复合终点和个体结局。
研究人群包括符合纳入标准的 359 名患者（HBP 组 163 名，LBBAP 组 196 名）。LBBAP 时的起搏 QRSd 与 HBP 相似（125±20.2 与 126±23.5 ms，p=0.643）。LBBAP 组（17.3%）与 HBP 组（24.5%）的主要复合结局无统计学差异（风险比[HR]：1.15，95%CI：0.72-1.82，p=0.552）。次要结局方面，死亡率（10%比 17%；HR：1.3，95%CI：0.73-2.33，p=0.38）和 HFH（10%比 12%；HR：1.02，95%CI：0.54-1.94，p=0.94）在两组之间无差异。
与 HBP 相比，LBBAP 的死亡率或 HFH 临床结局无统计学差异。
