Conduction System Pacing Upgrading is Favorable for Patients with Elective Replacement Indication and LVEF≪50%

Abstract

Objectives: This study aimed to investigate the safety and efficiency of conduction system pacing (CSP) upgrade on patients with elective replacement indication (ERI) and LVEF<50%.

Background: Studies focusing on the outcomes of CSP upgrade in patients with heart failure and ERI were extremely rare.

Methods: All the patients with LVEF<50% and ERI were continuously enrolled from January 2018 to October 2021, and all the patients were with ventricular pacing percentage>40%. Clinical data including echocardiographic parameters, electrocardiogram measurements and cardiac function were collected.

Results: A total of 60 patients with LVEF<50% accepted pulse generator replacement for ERI. Twenty-nine patients succeeded in CSP upgraded with the successful ratio of 90.63%. Among the patients with HFrEF, the final NYHA grade (P=0.010), LVEF (P=0.018) and QRS duration (P=0.022) improved obviously in 22 patients with CSP than 12 patients without CSP. Among the patients with HFmrEF, the final NYHA grade (P=0.010), LVEF (P=0.001) and the QRS duration (P<0.001) also improved obviously in 7 patients with CSP than 19 patients without CSP. The improvement range on LVEF, LVEDD and QRS duration were not different between the patients with HFrEF and HFmrEF (P>0.05), however, the NYHA grade improvement (P=0.007) and super-response ratio (P=0.053) were more common in HFrEF than HFmrEF. The pacing threshold remained stable (P=0.129) in patients with CSP upgrade.

Conclusion: CSP upgrading was safe and efficient during the pulse generator replacement for battery depletion, which obviously improved the cardiac performances on patients with LVEF<50%.

Note:
Funding Information: Supported by scientific and technological innovation Foundation of Dalian City (2020JJ26SN055).

Declaration of Interests: None declared.

Ethics Approval Statement: The study was approved by the ethics committee of the First Affiliated Hospital of Dalian Medical University (approval no. PJ-KS-KY-2023-100). Written informed consent was obtained from all the participants prior to the enrollment of this study.

Keywords: elective replacement indication, cardiac resynchronization therapy, heart failure, His bundle pacing, left bundle branch pacing