Author + information
- Received February 17, 2018
- Revision received February 27, 2018
- Accepted February 27, 2018
- Published online March 10, 2018.
- Mohamed Abdelrahman, MD∗,
- Faiz A. Subzposh, MD∗,
- Dominik Beer, DO#,
- Brendan Durr, DO#,
- Angela Naperkowski, RN, CEPS, CCDS, FHRS∗,
- Haiyan Sun, MS$,
- Jess W. Oren, MD#,
- Gopi Dandamudi, MD, FHRSˆ and
- Pugazhendhi Vijayaraman, MD, FACC∗∗ ( )()
- ∗Geisinger Heart Institute, Wilkes Barre, PA
- #Geisinger Heart Institute, Danville, PA
- $Biostatistics Core, Geisinger Medical Center, Danville, PA
- ˆIndiana University, Indianapolis, IN
- ↵∗Address for Correspondence: Pugazhendhi Vijayaraman, M.D. Director, Cardiac Electrophysiology Geisinger Heart Institute MC 36-10, 1000 E Mountain Blvd Wilkes-Barre, PA 18711 Telephone: 570 808 5995 Fax: 570 808 2306.
Background Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP.
Objective The aim of the study is to evaluate clinical outcomes of HBP compared to RVP.
Methods All patients requiring initial pacemaker implantation between Oct 1st, 2013 and December 31st, 2016 were included in the study. Permanent HBP was attempted in consecutive patients at one 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 (92%) consecutive patients while 433 patients underwent RVP. The primary endpoint of death, HFH or upgrade to BiVP was significantly reduced in the HBP group (83 of 332, 25%) compared to RVP (137 of 433, 32%; HR 0.71, 95% CI 0.534-0.944; p=0.02). This difference was primarily in pts with ventricular pacing > 20% (25% in HBP vs 36% in RVP, HR 0.65, 95% CI 0.456-0.927; p=0.02). The incidence of HFH was significantly reduced in HBP (12.4% vs 17.6%, HR 0.63, 95% CI 0.430-0.931; p=0.02). There was a trend towards reduced mortality in HBP (17.2% vs 21.4%, 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.
Disclosures: MA, DB, BD, AN, HS, JWO – None; FAS – Speaker (Medtronic); GD - Speaker, Consultant, Research (Medtronic);PV - Speaker, Consultant, Research (Medtronic), Consultant (Boston Scientific, Abbott); patent pending for a His delivery tool
- Received February 17, 2018.
- Revision received February 27, 2018.
- Accepted February 27, 2018.