BACKGROUND:Right ventricular apical pacing (RVAP) can produce left ventricle dysfunction. Conduction system pacing (CSP) has been used successfully to reverse left ventricle dysfunction in patients with left bundle branch block. To date, data about CSP prevention of left ventricle dysfunction in patients with preserved left ventricular ejection fraction (LVEF) are scarce and limited mostly to nonrandomized studies. Our aim is to demonstrate that CSP can preserve normal ventricular function compared with RVAP in the setting of a high burden of ventricular pacing.METHODS:Consecutive patients with a high-degree atrioventricular block and preserved or mildly deteriorated LVEF (>40%) were included in this prospective, randomized, parallel, controlled study, comparing conventional RVAP versus CSP.RESULTS:Seventy-five patients were randomized, with no differences between basal characteristics in both groups. The stimulated QRS duration was significantly longer in the RVAP group compared with the CSP group (160.4±18.1 versus 124.2±20.2 ms; p<0.01). Seventy patients were included in the intention-to-treat analyses. LVEF showed a significant decrease in the RVAP group at 6 months compared with the CSP group (mean difference, −5.8% [95% CI, −9.6% to −2%]; P<0.01). Left ventricular end-diastolic diameter showed an increase in the RVAP group compared with the CSP group (mean difference, 3.2 [95% CI, 0.1–6.2] mm; P=0.04). Heart failure–related admissions were higher in the RVAP group (22.6% versus 5.1%; P=0.03).CONCLUSIONS:Conduction system stimulation prevents LVEF deterioration and heart failure–related admissions in patients with normal or mildly deteriorated LVEF requiring a high burden of ventricular pacing. These results are only short term and need to be confirmed by further larger studies.REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06026683.

中文翻译：

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传导系统刺激以避免左心室功能障碍

背景：右心室心尖起搏（RVAP）可引起左心室功能障碍。传导系统起搏（CSP）已成功用于逆转左束支传导阻滞患者的左心室功能障碍。迄今为止，关于 CSP 预防左心室射血分数 (LVEF) 保留的患者左心室功能障碍的数据很少，并且主要限于非随机研究。我们的目的是证明，在心室起搏负荷较高的情况下，与 RVAP 相比，CSP 可以保留正常的心室功能。 方法：纳入了连续患有高度房室传导阻滞且 LVEF 保持或轻度恶化 (>40%) 的患者在这项前瞻性、随机、平行、对照研究中，比较了传统 RVAP 与 CSP。 结果：75 名患者被随机分组​​，两组的基本特征没有差异。与 CSP 组相比，RVAP 组的刺激 QRS 持续时间显着更长（160.4±18.1 vs 124.2±20.2 ms；p <0.01）。意向治疗分析中纳入了 70 名患者。与 CSP 组相比，RVAP 组在 6 个月时 LVEF 显着降低（平均差为 -5.8% [95% CI，-9.6% 至 -2%]；P <0.01）。与 CSP 组相比，RVAP 组的左心室舒张末期内径有所增加（平均差异，3.2 [95% CI，0.1–6.2] mm；P = 0.04）。RVAP 组中心力衰竭相关入院率较高（22.6% 对比 5.1%；P =0.03）。结论：对于 LVEF 正常或轻度恶化且需要高负荷的患者，传导系统刺激可以预防 LVEF 恶化和心力衰竭相关入院。心室起搏。这些结果只是短期的，需要通过进一步更大规模的研究来证实。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT06026683。