Conduction system pacing preserved septal myocardial work index (1520 mmHg%) over 27 weeks, while right ventricular pacing reduced it from 1645 to 925 mmHg% (p=0.03).
Does conduction system pacing preserve left ventricular mechanics better than right ventricular pacing in patients with atrioventricular block requiring pacemakers?
Conduction system pacing preserves septal myocardial work significantly better than traditional right ventricular pacing, providing mechanistic evidence for its role in preventing pacing-induced left ventricular dyssynchrony.
Absolute Event Rate: 0% vs 0%
Abstract Introduction For the past sixty years, right ventricular pacing (RVP) has been the primary therapeutic choice for bradyarrhythmia, although it has been linked to unfavourable left ventricular (LV) remodelling and an increased risk of heart failure (HF). Conduction system pacing (CSP) is a possible alternate pacing strategy, however its effectiveness in reducing LV dyssynchrony is unknown. Echocardiography is a crucial tool for understanding LV function and mechanics and may provide some mechanistic insights. Purpose To assess LV mechanics induced from CSP in comparison to RVP using echocardiographic derived myocardial work (MW) measurements. Methods Patients with atrioventricular block who needed pacemakers were recruited prospectively from October 2022 to October 2024 at a single tertiary hospital in the United Kingdom. Patients receiving CSP and RVP were pair-matched at baseline according to age and gender. Data were obtained pre-implant, 0-6 weeks post-implant (acute), and 6 months post-implant (mid-term). The primary outcome was difference over time in septal and lateral MW measurements between the two groups. Results Eighteen patients (CSP n=9, RVP n=9), 78% male with a mean age 66 (±11) years, were included for analysis. After a median follow-up of 27 weeks (IQR: 25-28), septal work index in CSP patients (1458±615 to 1520±586 mmHg%) remained stable, but decreased in RVP patients (1645±498 to 925±392 mmHg%) overtime, with statistically significant difference observed between groups (p=0.03). Meanwhile, lateral work index increased in both CSP and RVP patients overtime (1648±877 to 1994±736 mmHg% vs. 1433±772 to 1769±621 mmHg%, respectively, p=0.75). Conclusions Regional myocardial work analysis is useful to identify early changes in LV mechanics after initiation of pacemaker therapy. The findings suggests that CSP protects septal MW better than RVP in age and sex matched patients, potentially providing mechanistic insights into the effects of emerging bradycardia pacing strategies.
Partheban et al. (Sat,) reported a other. Conduction system pacing preserved septal myocardial work index (1520 mmHg%) over 27 weeks, while right ventricular pacing reduced it from 1645 to 925 mmHg% (p=0.03).