Author + information
- Received April 19, 2019
- Revision received April 24, 2019
- Accepted April 24, 2019
- Published online May 10, 2019.
- Dominik Beer, DOa,
- Parikshit S. Sharma, MD, MPHb,
- Faiz A. Subzposh, MDa,
- Angela Naperkowski, RNa,
- Grzegorz Marcin Pietrasik, MD, MPHb,
- Brendan Durr, DOa,
- Maria Qureshi, MDa,
- Ragesh Panikkath, MDa,
- Mohamed Abdelrahman, MDc,
- Brent A. Williams, PhDa,
- Jillian L. Hanifin, RNb,
- Ryan Zimberg, RNb,
- Kelly Austin, RNa,
- Brooke Macuch, RNa,
- Richard G. Trohman, MD, MBAb,
- Erin A. Vanenkevort, PhDd,
- Gopi Dandamudi, MDe and
- Pugazhendhi Vijayaraman, MDa,∗
- aGeisinger Heart Institute, Wilkes Barre, PA
- bRush University Medical Center, Chicago, IL
- cWeil Cornell Medicine – New York Presbyterian Hospital, NY, NY
- dBiostatistics Core, Geisinger Medical Center, Danville, PA
- eIndiana University, Indianapolis, IN
- ↵∗Address for Correspondence: Pugazhendhi Vijayaraman, M.D. Director, Cardiac Electrophysiology Professor of Medicine Geisinger Commonwealth School of Medicine Geisinger Heart Institute MC 36-10; 1000 E Mountain Blvd Wilkes-Barre, PA 18711 Tel: 570 808 3137; Fax: 570 808 2306.
Background His bundle pacing (HBP) is the most physiologic form of ventricular pacing. Nonselective (NS)-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared to selective (S)-HBP wherein there is exclusive His bundle capture and conduction.
Objective The aim of the study was to evaluate the clinical outcomes of NS-HBP compared to S-HBP.
Methods The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥ 20% ventricular pacing burden 3 months post-implant. Patients were categorized into S-HBP or NS-HBP based upon QRS morphology (NS-HBP n=232; S-HBP n=118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization (HFH).
Results The NS-HBP group had a higher number of men (64% vs 50%, p=0.01), higher incidence of infra-nodal AV block (40% vs 9%, p<0.01), ischemic cardiomyopathy (24 vs 14%, p=0.03), and permanent AF (18 vs 8%, p=0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared to 23 of 118 (19%) in the S-HBP group (HR 1.38; 95% CI 0.87-2.20, p=0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower LVEF) revealed no incremental risk with NS-HBP.
Conclusion NS-HBP was associated with similar outcomes of death or HFH when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
Funding Source: None
DB, AN, BD, MQ, RP, BAW, GMP, JH, RZ, KA, BM, EAV: None; PSS: Speaker (Medtronic), Consultant (Abbott, Biotronik); FAS – Speaker (Medtronic); RGT – advisory board: Boston Scientific; research grants: Boston Scientific, Medtronic Inc, Abbott, Vitatron, and Wyeth-Ayerst/Wyeth Pharmaceuticals; consultant: Biosense Webster, Abbott and AltaThera Pharmaceuticals; honoraria: Boston Scientific, Medtronic Inc, Daiichi Sankyo, AltaThera Pharmaceuticals and Abbott; GD - Speaker, Consultant, Research (Medtronic); PV - Speaker, Consultant, Research (Medtronic), Consultant (Boston Scientific, Abbott, Biotronik), patent pending for a His delivery tool.
- Received April 19, 2019.
- Revision received April 24, 2019.
- Accepted April 24, 2019.
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