Author + information
- Received February 17, 2018
- Revision received February 27, 2018
- Accepted February 27, 2018
- Published online May 14, 2018.
- Mohamed Abdelrahman, MDa,
- Faiz A. Subzposh, MDa,
- Dominik Beer, DOb,
- Brendan Durr, DOb,
- Angela Naperkowski, RN, CEPS, CCDSa,
- Haiyan Sun, MSc,
- Jess W. Oren, MDb,
- Gopi Dandamudi, MDd and
- Pugazhendhi Vijayaraman, MDa,∗ ( )()
- aGeisinger Heart Institute, Wilkes Barre, Pennsylvania
- bGeisinger Heart Institute, Danville, Pennsylvania
- cBiostatistics Core, Geisinger Medical Center, Danville, Pennsylvania
- dDivision of Cardiology, Indiana University, Indianapolis, Indiana
- ↵∗Address for correspondence:
Dr. Pugazhendhi Vijayaraman, Cardiac Electrophysiology, Geisinger Heart Institute, MC 36-10, 1000 East Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711.
Background Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP.
Objectives This study sought to evaluate clinical outcomes of HBP compared to RVP.
Methods All patients requiring initial pacemaker implantation between October 1, 2013, and December 31, 2016, were included in the study. Permanent HBP was attempted in consecutive patients at 1 hospital and RVP at a sister hospital. Implant characteristics, all-cause mortality, heart failure hospitalization (HFH), and upgrades to biventricular pacing (BiVP) were tracked. Primary outcome was the combined endpoint of death, HFH, or upgrade to BiVP. Secondary endpoints were mortality and HFH.
Results HBP was successful in 304 of 332 consecutive patients (92%), whereas 433 patients underwent RVP. The primary endpoint of death, HFH, or upgrade to BiVP was significantly reduced in the HBP group (83 of 332 patients [25%]) compared to RVP (137 of 433 patients [32%]; hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.534 to 0.944; p = 0.02). This difference was observed primarily in patients with ventricular pacing >20% (25% in HBP vs. 36% in RVP; HR: 0.65; 95% CI: 0.456 to 0.927; p = 0.02). The incidence of HFH was significantly reduced in HBP (12.4% vs. 17.6%; HR: 0.63; 95% CI: 0.430 to 0.931; p = 0.02). There was a trend toward reduced mortality in HBP (17.2% vs. 21.4%, respectively; p = 0.06).
Conclusions Permanent HBP was feasible and safe in a large real-world population requiring permanent pacemakers. His bundle pacing was associated with reduction in the combined endpoint of death, HFH, or upgrade to BiVP compared to RVP in patients requiring permanent pacemakers.
Dr. Subzposh has received speaker fees from Medtronic. Dr. Dandamudi has received speaker and consultant fees and research support from Medtronic. Dr. Vijayaraman has received speaker and consultant fees and research support from Medtronic; and is a consultant for Boston Scientific and Abbott. All other authors have reported that they have no relationships with industry relevant to the contents of this paper to disclose.
- Received February 17, 2018.
- Revision received February 27, 2018.
- Accepted February 27, 2018.
- 2018 American College of Cardiology Foundation