Effectiveness and safety of upgrading to conduction system pacing compared with biventricular pacing in patients with pacing-induced cardiomyopathy: Results of a propensity score-matched analysis from a multicenter registry

BACKGROUND Upgrading to biventricular pacing (BVP) is currently the standard treatment for patients with pacing-induced cardiomyopathy (PICM). Although emerging literature suggests that upgrading to conduction system pacing (CSP) (including His bundle pacing and left bundle branch area pacing) could be an effective alternative to BVP in the treatment of PICM, comparative data between these 2 upgrading strategies are lacking. OBJECTIVE This study aimed to compare the effectiveness and safety of upgrading between CSP and BVP in a cohort of patients with PICM. METHODS Prospective, multicenter, observational study enrolling 183 consecutive patients with PICM (54.1% with New York Heart Association [NYHA] class >II; mean left ventricular ejection fraction [LVEF] 33.2% 6 8.4%), who underwent upgrading to CSP (n 5 69, of which 52 left bundle branch area pacing and 17 His bundle pacing) or BVP (n 5 114). Propensity matching for baseline characteristics yielded 57 matched pairs. The primary end point was a composite of all-cause death and heart failure hospitalization. Secondary end points included the incidence of procedure-related complications and the change in LVEF and in NYHA class from baseline to 12-month follow-up. RESULTS During a median follow-up of 22.8 months, the primary end point occurred in 6 patients with CSP (10.5%) and in 17 patients with BVP (29.8%) (P 5 .010). Procedure-related complications occurred in 2 patients with CSP (3.5%) and in 8 patients with BVP (14.0%) (P 5 .047). Upgrading to CSP was associated with a significantly greater improvement in LVEF (115.3 6 7.3 vs 111.1 6 13.5%; P 5 .039) and NYHA class (21.3 6 0.7 vs 20.8 6 0.8; P < .001) at 12 months than BVP. CONCLUSION In patients with PICM, upgrading to CSP could reduce the risk of all-cause death or heart failure hospitalization, as well as the incidence of procedure-related complications, compared with BVP.