Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease

Jeremy P Moore; Natasja M S de Groot; Matthew O'Connor; Daniel Cortez; Jonathan Su; Austin Burrows; Kevin M Shannon; Edward T O'Leary; Maully Shah; Paul Khairy; Joseph Atallah; Tom Wong; Michael S Lloyd; Yannick J H J Taverne; Anne M Dubin; Jens C Nielsen; Reinder Evertz; Richard J Czosek; Malini Madhavan; Philip M Chang; Alper Aydin; Óscar Cano

doi:10.1016/j.jacep.2022.10.012

Conduction System Pacing Versus Conventional Cardiac Resynchronization Therapy in Congenital Heart Disease

JACC Clin Electrophysiol. 2023 Mar;9(3):385-393. doi: 10.1016/j.jacep.2022.10.012. Epub 2022 Nov 30.

Authors

Jeremy P Moore¹, Natasja M S de Groot², Matthew O'Connor³, Daniel Cortez⁴, Jonathan Su⁵, Austin Burrows⁶, Kevin M Shannon⁷, Edward T O'Leary⁸, Maully Shah⁹, Paul Khairy¹⁰, Joseph Atallah¹¹, Tom Wong³, Michael S Lloyd¹², Yannick J H J Taverne¹³, Anne M Dubin¹⁴, Jens C Nielsen¹⁵, Reinder Evertz¹⁶, Richard J Czosek¹⁷, Malini Madhavan¹⁸, Philip M Chang¹⁹, Alper Aydin²⁰, Óscar Cano²¹

Affiliations

¹ Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA; Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA. Electronic address: jpmoore@mednet.ucla.edu.
² Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
³ Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
⁴ Adult Congenital Cardiology and Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA; Adult Congenital Cardiology and Pediatric Cardiology, UC Davis Medical Center, Sacramento, California, USA.
⁵ Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA.
⁶ David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
⁷ Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California Los Angeles Medical Center, Los Angeles, California, USA; Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA; Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California, USA.
⁸ Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
⁹ Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
¹¹ Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
¹² Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
¹³ Department of Cardiothoracic Surgery, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
¹⁴ Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA.
¹⁵ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
¹⁶ Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁷ Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
¹⁸ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
¹⁹ Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.
²⁰ Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
²¹ Área de Enfermedades Cardiovasculares, Hospital Universitari i Politècnic La Fe, Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares, Valencia, Spain.

PMID: 36752449
DOI: 10.1016/j.jacep.2022.10.012

Abstract

Background: Dyssynchrony-associated left ventricular systolic dysfunction is a major contributor to heart failure in congenital heart disease (CHD). Although conventional cardiac resynchronization therapy (CRT) has shown benefit, the comparative efficacy of cardiac conduction system pacing (CSP) is unknown.

Objectives: The purpose of this study was compare the clinical outcomes of CSP vs conventional CRT in CHD with biventricular, systemic left ventricular anatomy.

Methods: Retrospective CSP data from 7 centers were compared with propensity score-matched conventional CRT control subjects. Outcomes were lead performance, change in left ventricular ejection fraction (LVEF), and QRS duration at 12 months.

Results: A total of 65 CSP cases were identified (mean age 37 ± 21 years, 46% men). The most common CHDs were tetralogy of Fallot (n = 12 [19%]) and ventricular septal defect (n = 12 [19%]). CSP was achieved after a mean of 2.5 ± 1.6 attempts per procedure (38 patients with left bundle branch pacing, 17 with HBP, 10 with left ventricular septal myocardial). Left bundle branch area pacing [LBBAP] vs HBP was associated with a smaller increase in pacing threshold (Δ pacing threshold 0.2 V vs 0.8 V; P = 0.05) and similar sensing parameters at follow-up. For 25 CSP cases and control subjects with baseline left ventricular systolic dysfunction, improvement in LVEF was non-inferior (Δ LVEF 9.0% vs 6.0%; P = 0.30; 95% confidence limits: -2.9% to 10.0%) and narrowing of QRS duration was more pronounced for CSP (Δ QRS duration 35 ms vs 14 ms; P = 0.04). Complications were similar (3 [12%] CSP, 4 [16%] conventional CRT; P = 1.00).

Conclusions: CSP can be reliably achieved in biventricular, systemic left ventricular CHD patients with similar improvement in LVEF and greater QRS narrowing for CSP vs conventional CRT at 1 year. Among CSP patients, pacing electrical parameters were superior for LBBAP vs HBP.

Keywords: His bundle pacing; conduction system pacing; congenital heart disease; electromechanical dyssynchrony; left bundle branch area pacing.

Published by Elsevier Inc.

MeSH terms

Adolescent
Adult
Bundle of His
Bundle-Branch Block
Cardiac Conduction System Disease
Cardiac Resynchronization Therapy* / adverse effects
Electrocardiography
Female
Heart Defects, Congenital* / complications
Heart Defects, Congenital* / therapy
Humans
Male
Middle Aged
Retrospective Studies
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Left* / therapy
Ventricular Function, Left
Young Adult