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Selective, nonselective His bundle pacing strategies confer similar HF, mortality outcomes

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SAN FRANCISCO — Patients who underwent nonselective His bundle pacing had similar rates of HF hospitalization and mortality compared with selective His bundle pacing, according to findings presented at the Heart Rhythm Society Annual Scientific Sessions.

Dominik Beer

Dominik Beer, DO, and colleagues evaluated the clinical outcomes of nonselective His bundle pacing compared with selective His bundle pacing.

“Right ventricle pacing has been associated with a higher incidence of atrial fibrillation, heart failure and mortality,” Beer, an internist at Geisinger Heart Institute in Wilkes Barre, Pennsylvania, said during a press conference. “Depending on the lead, His bundle pacing can result in zero or varying degrees of myocardial infusion.”

For the nonrandomized study, the researchers included 350 consecutive patients who were treated with His bundle pacing for bradyarrhythmic indications and demonstrated 20% or greater ventricular pacing burden 3 months after implantation.

Patients were stratified into selective and nonselective His bundle pacing groups based on QRS morphology, Beer and colleagues wrote in a simultaneous publication in JACC Clinical Electrophysiology. The primary outcome was all-cause mortality or HF hospitalization.

The researchers discerned the nonselective His bundle pacing group had more men(64% vs, 50%, P < .01) and greater incidence of infra-nodal atrioventricular block (40% vs 9%, P < .01) compared with the selective His bundle pacing group. Ischemic cardiomyopathy (24% vs. 14%, P = .03) and permanent AF (18% vs. 8%, P = .01) were also higher in the nonselective His bundle pacing group.

Patients who underwent nonselective His bundle pacing had similar rates of HF hospitalization and mortality compared with selective His bundle pacing.

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The primary endpoint was numerically but not significantly higher in the nonselective His bundle pacing group compared with the selective His bundle pacing group (35% vs 19%; HR = 1.382; 95% CI, 0.867-2.204), Beer and colleagues wrote.

In subgroup analyses of patients with the highest pacing burden and the lowest left ventricular ejection fraction, there was also no excess risk posed by nonselective His bundle pacing, according to the researchers.

“Multicenter risk-matched clinical studies are needed to confirm these findings,” the researchers wrote in JACC Clinical Electrophysiology. – by Earl Holland Jr.

References:

Beer D, et al. LBCT03-02. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 8-11, 2019; San Francisco.

Beer, D, et al. JACC Clin Electrophysiol. 2019;doi:10.1016/j.jacep.2019.04.008.

Disclosures: Beer reports no relevant financial disclosures. Please see the study for a list of the other authors’ relevant financial disclosures.