Outcomes of conduction system pacing for cardiac resynchronization therapy in patients with heart failure: A multicenter experience

BACKGROUND Whether conduction system pacing (CSP) is an alternative option for cardiac resynchronization therapy (CRT) in patients with heart failure remains an area of active investigation. OBJECTIVE The purpose of this study was to assess the echocardio-graphic and clinical outcomes of CSP compared to biventricular pac-ing (BiVP). METHODS This multicenter retrospective study included patients who fulfilled CRT indications and received CSP. Patients with CSP were matched using propensity score matching and compared in a 1:1 ratio to patients who received BiVP. Echocardiographic and clin-ical outcomes were assessed. Response to CRT was defined as an ab-solute increase of >5% in left ventricular ejection fraction (LVEF) at 6 months post-CRT. RESULTS A total of 238 patients were included. Mean age was 69.8 12.5 years, and 66 (27.7%) were female. Sixty-nine patients (29%) had His-bundle pacing, 50 (21%) had left bundle branch area pacing, and 119 (50%) had BiVP. Mean follow-up duration in the CSP and BiVP groups was 269 +/- 202 days and 304 +/- 262 days, respectively (P = .293). The proportion of CRT responders was greater in the CSP group than in the BiVP group (74% vs 60%, respectively; P = .042). On Kaplan-Meier analysis, there was no statistically significant difference in the time to first heart failure hospitalization (log-rank P = .78) and overall survival (log-rank P = .68) between the CSP and BiVP groups. CONCLUSION In patients with heart failure and reduced ejection fraction, CSP resulted in greater improvement in LVEF compared to BiVP. Large-scale randomized trials are needed to validate these outcomes and further investigate the different options available for CSP.