医学
心动过缓
危险系数
内科学
心脏病学
心力衰竭
心室起搏
入射(几何)
心脏再同步化治疗
束支阻滞
心脏传导系统
置信区间
心率
心电图
射血分数
血压
光学
物理
作者
Esther Tan,Rodney Soh,Jie‐Ying Lee,Elaine Boey,Kian-Hui Ho,Shana Aguirre,Jhobeleen de Leon,Siew-Pang Chan,Swee‐Chong Seow,Pipin Kojodjojo
标识
DOI:10.1016/j.jacep.2022.10.016
摘要
Conduction system pacing (CSP) provides more physiological ventricular activation than right ventricular pacing (RVP). This study evaluated the differences in clinical outcomes in patients receiving CSP and RVP. Consecutive patients with pacemakers implanted for bradycardia from 2016 to 2021 in 2 centers were prospectively followed for the primary composite outcome of heart failure (HF) hospitalizations, upgrade to biventricular pacing, or all-cause mortality, stratified by ventricular pacing burden (Vp) . Among 860 patients (mean age 74 ± 11 years, 48% female, 48% atrioventricular block), 628 received RVP and 231 received CSP (95 His-bundle pacing, 136 left bundle branch pacing). The primary outcome occurred in 217 (25%) patients, more commonly in patients with RVP than CSP (30% vs 13%, P < 0.001). In multivariable analyses, CSP was independently associated with 47% reduction of the primary outcome (adjusted hazard ratio [AHR]: 0.53; 95% CI: 0.29-0.97; P = 0.04) and HF hospitalization alone (AHR: 0.40; 95% CI: 0.17-0.95; P = 0.04), among only patients with Vp >20%. The incidence of the primary outcome was highest among RVP with Vp >20% and lowest in CSP with Vp >20% (35% vs 10%, P < 0.001). Compared with RVP with Vp >20%, both CSP with Vp >20% (AHR: 0.51; 95% CI: 0.28-0.91; P = 0.02) and all patients with Vp ≤20% (AHR: 0.73; 95% CI: 0.54-0.99; P = 0.04) were independently associated with reduced primary outcome, driven primarily by reductions in HF hospitalizations (P < 0.05). Event-free survival was similar between CSP with Vp >20% and those needing ≤20% Vp. CSP significantly reduced adverse clinical outcomes for bradycardic patients requiring ventricular pacing and should be the preferred pacing modality of choice.
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