Rate and nature of complications of conduction system pacing compared with right ventricular pacing: Results of a propensity score-matched analysis from a multicenter registry

Heart Rhythm. 2023 Jul;20(7):984-991. doi: 10.1016/j.hrthm.2023.03.009. Epub 2023 Mar 10.

Abstract

Background: Conduction system pacing (CSP) using His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) has emerged as an alternative to right ventricular pacing (RVP). Comparative data on the risk of complications between CSP and RVP are lacking.

Objective: This prospective, multicenter, observational study aimed to compare the long-term risk of device-related complications between CSP and RVP.

Methods: A total of 1029 consecutive patients undergoing pacemaker implantation with CSP (including HBP and LBBAP) or RVP were enrolled. Propensity score matching for baseline characteristics yielded 201 matched pairs. The rate and nature of device-related complications occurring during follow-up were prospectively collected and compared between the 2 groups.

Results: During a mean follow-up duration of 18 months, device-related complications were observed in 19 patients: 7 in RVP (3.5%) and 12 in CSP (6.0%) (P = .240). On dividing the matched cohort into 3 groups with similar baseline characteristics according to pacing modality (RVP, n = 201; HBP, n = 128; LBBAP, n = 73), patients with HBP showed a significantly higher rate of device-related complications than did patients with RVP (8.6% vs 3.5%; P = .047) and patients with LBBAP (8.6% vs 1.3%; P = .034). Patients with LBBAP showed a rate of device-related complications similar to that of patients with RVP (1.3% vs 3.5%; P = .358). Most of the complications observed in patients with HBP (63.6%) were lead related.

Conclusion: Globally, CSP was associated with a risk of complications similar to that of RVP. Considering HBP and LBBAP separately, HBP showed a significantly higher risk of complications than did both RVP and LBBAP whereas LBBAP showed a risk of complications similar to that of RVP.

Keywords: Complications; Conduction system pacing; His bundle pacing; Lead-related complications; Left bundle branch area pacing; Right ventricular pacing.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Bundle of His*
  • Cardiac Conduction System Disease
  • Cardiac Pacing, Artificial* / adverse effects
  • Cardiac Pacing, Artificial* / methods
  • Electrocardiography / methods
  • Humans
  • Propensity Score
  • Prospective Studies
  • Treatment Outcome