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ORIGINAL RESEARCH article

Front. Physiol.
Sec. Cardiac Electrophysiology
Volume 15 - 2024 | doi: 10.3389/fphys.2024.1500159

Is Conduction System Pacing More Effective than Right Ventricular Pacing in Reducing Atrial High-Rate Episodes in Patients with Heart Failure and Preserved Ejection Fraction?

Provisionally accepted
Ying Chen Ying Chen Lin Zhu Ma Lin Zhu Ma Fei Liu Fei Liu Wang Nan Wang Nan Yang Yue Ma Yang Yue Ma An Zi Guan An Zi Guan Chuan Zhuang Zhe Chuan Zhuang Zhe Yun Long Xia Yun Long Xia Xue Ying Dong Xue Ying Dong *
  • First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning Province, China

The final, formatted version of the article will be published soon.

    The relationship between conduction system pacing (CSP) and the incidence of atrial fibrillation (AF) in patients with heart failure and preserved ejection fraction (HFpEF) remains uncertain. This study aims to investigate the occurrence of atrial high-rate episodes (AHREs) following CSP in patients with HFpEF, in comparison to right ventricular pacing (RVP).Methods: Patients with HFpEF who received dual-chamber pacemakers for atrioventricular block were retrospectively enrolled from January 2018 to January 2023. Both new-onset and progressive AHREs were recorded, along with other clinical data, including cardiac performance and lead outcomes.Results: A total of 498 patients were enrolled, comprising 387 patients with RVP and 111 patients with CSP, with a follow-up duration of 44.42 ± 10.41 months. In patients without a prior history of AF, CSP was associated with a significantly lower incidence of new-onset AHREs when the percentage of ventricular pacing was ≥20% (9.52% vs. 29.70%, P = 0.001).After adjusting for confounding factors, CSP exhibited a lower hazard ratio for new-onset AHREs compared to RVP (HR 0.336; [95% CI: 0.142-0.795]; P = 0.013), alongside left atrial diameter (LAD) (HR 1.109; [95% CI: 1.048-1.173]; P < 0.001). In patients with a history of AF, the progression of AHREs in CSP and RVP did not differ significantly (32.35% vs.34.75%, P = 0.791). Cardiac performance metrics, including left ventricular end-diastolic diameter (LVEDD) (49.09 ± 4.28mm vs. 48.08 ± 4.72mm; P = 0.015), LAD (40.68 ± 5.49mm vs. 39.47 ± 5.24mm; P = 0.001), and NYHA class (2.31 ± 0.46 vs. 1.59 ± 0.73; P < 0.001), improved obviously following CSP, while LVEDD (48.37 ± 4.57mm vs. 49.30 ± 5.32mm; P < 0.001), LAD (39.77 ± 4.58mm vs. 40.83 ± 4.80mm; P < 0.001), NYHA class (2.24 ± 0.43 vs. 2.35 ± 0.83; P = 0.018), and left ventricular ejection fraction (LVEF) (57.41 ± 2.42 vs. 54.24 ± 6.65; P < 0.001) deteriorated after RVP.Our findings suggest that CSP may be associated with improvements in cardiac performance and a reduction in new-onset AHREs compared to RVP in patients with HFpEF. However, prospective randomized trials are anticipated to confirm these potential benefits.

    Keywords: Conduction system pacing, Right ventricular pacing, Atrial high-rate episodes, Atrial Fibrillation, heart failure with preserved ejection fraction

    Received: 22 Sep 2024; Accepted: 19 Nov 2024.

    Copyright: © 2024 Chen, Ma, Liu, Nan, Ma, Guan, Zhe, Xia and Dong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xue Ying Dong, First Affiliated Hospital, Dalian Medical University, Dalian, 116011, Liaoning Province, China

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