Background: Multiple reports have demonstrated that HBP is feasible and is associated with an improvement in exercise capacity, myocardial perfusion, ventricular synchrony and LVEF compared to RV pacing. However, permanent HBP has not gained widespread acceptance in clinical practice because of perceived difficulties including procedure length, and concerns about long term capture thresholds and reliability of distal conduction. There are several registry studies demonstrating safety, reliability, and feasibility of permanent HBP. To date, there is a paucity of multi-center registry studies or randomized, controlled trials published.
Objective: To evaluate lead survival and adverse CV events (death or HF hospitalization) at 6 and 12 months.
Methods: This was a retrospective, non-randomized, multicenter analysis. Six centers enrolled subjects who received a PPM with HBP lead for a standard indication. One hundred subjects who received conventional RV pacing served as a control group. Lead failure was defined as a threshold exceeding 4 Volts.
Results: One hundred forty eight patients received a HBP lead. There was a trend (p=0.06) toward fewer adverse CV events with HBP. Lead failure rates were not statistically different at 6 (1% vs. 5.4%, p=0.08 but were at 12 months (1% vs. 6.7%, p=0.04). Those who received a HBP lead were more likely to experience an increase in LVEF at 12 months (P<0.01).
Conclusion: HBP should be considered in patients with preserved ejection fraction and PPM indication.