Author + information
- Received April 19, 2019
- Revision received April 24, 2019
- Accepted April 24, 2019
- Published online July 15, 2019.
- Dominik Beer, DOa,
- Parikshit S. Sharma, MD, MPHb,
- Faiz A. Subzposh, MDa,
- Angela Naperkowski, RNa,
- Grzegorz M. 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,∗ ()
- aDivision of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
- bDivision of Cardiology, Rush University Medical Center, Chicago, Illinois
- cDivision of Cardiology, Weil Cornell Medicine–New York Presbyterian Hospital, New York, New York
- dBiostatistics Core, Geisinger Medical Center, Danville, Pennsylvania
- eDivision of Cardiology, Indiana University, Indianapolis, Indiana
- ↵∗Address for correspondence:
Dr. Pugazhendhi Vijayaraman, Cardiac Electrophysiology, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 East Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711.
Objectives The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP.
Background HBP is the most physiologic form of ventricular pacing. 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 with S-HBP wherein there is exclusive His bundle capture and conduction.
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-implantation. Patients were categorized into S-HBP or NS-HBP based on 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.
Results The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP.
Conclusions NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
Dr. Sharma has received speaking honoraria from Medtronic; and consulting honoraria from Medtronic, Abbott, and Biotronik. Dr. Subzposh has received speaking honoraria from Medtronic. Dr. Trohman has served on the advisory board of Boston Scientific/Guidant; has received research grants from Boston Scientific/Guidant, Medtronic, St. Jude Medical (Abbott), Vitatron, and Wyeth-Ayerst/Wyeth Pharmaceuticals; has received consulting honoraria from Biosense Webster, St. Jude Medical (Abbott), and AltaThera Pharmaceuticals; has received speaking or other honoraria from Boston Scientific/Guidant, Medtronic, Daiichi Sankyo, AltaThera Pharmaceuticals, and St. Jude Medical (Abbott). Dr. Dandamundi has received speaking and consulting honoraria and research funding from Medtronic. Dr. Vijayaraman has received speaking honoraria and research funding from Medtronic; has received consulting honoraria from Medtronic, Boston Scientific, Abbott, and Biotronik; and has a patent pending for a His delivery tool. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 19, 2019.
- Revision received April 24, 2019.
- Accepted April 24, 2019.
- 2019 American College of Cardiology Foundation
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