Evaluation Of Efficacy And Safety On His-purkinje Conduction System Pacing In Patients With Atrioventricular Block

OBJECTIVE: Artificial cardiac pacing as a effective and safe treatement for atrioventricular block patients has been widely applied in clinical.More and more evidences have shown right ventricular.endocardial pacing(RVP)as the most commonly pacing stie could increase the incidence of atrial fibrillation(AF),pacemaker-induced cardiomyopathy(pacemaker-induced cardiomyopathy,PICM),heart failure(heart failure,HF),and even increase the hospitalization and death.Recent studies have demonstrated that His-Purkinje conduction system pacing(HPCSP)as a more physiological pacing method could improve survival rate and quality of life.The purpose of this study was aimed to evaluate the efficacy and safety of HPCSP in atrioventricular block patients by comparing and analyzing the pacing electrical parameters and clinical outcomes of RVP and HPCSP in patients with AV block.METHODS: A total of 117 patients with atrioventricular block who underwent permanent pacemaker implantation in the Heart Center of Zhongshan Hospital Affiliated to Dalian University from March 2020 to October 2021 were enrolled,including 54 cases in the Hispanic system pacing group(HPCSP group),63 cases in the ventricular pacing group(RVP group).The clinical baseline characteristics,operation time,and intraoperative X-ray exposure time of the two groups were compared.QRS wave duration of ECG and pacing parameters(atrial/ventricular threshold,perception,impedance)were compared before operation and at 12 months after operation.The rates of surgeryrelated complications,postoperative adverse events and rehospitalization between the two groups were also be compared.RESULTS:(1)Comparison of Clinical Parameters:A total of 117 patients were enrolled,including 54 who were inmplated with HPCSP,and 63 with RVP.The average age of the patients was(74.42±9.41)years old,and 55.5% of them were male.The two groups of patients had no statistical difference in age,gender,comorbidities,ventricular rate,QRS duration,QTC interval and cardiac ultrasound-related indicators such as left ventricular end diastolic diameter,interventricular septal thickness,LVEF,etc.(P>0.05);But,patients with tricuspid regurgitation,HPCSP group was significantly more than RVP group(P <0.05).(2)Comparison of surgery-related indicators:There was no significant difference in the operation time and X-ray exposure time between the two groups(P>0.05),and the average ventricular electrode implantation time in group HPCSP was longer than that in group RVP(12.93±3.34 min vs 11.62±3.15 min,P<0.05),the X-ray exposure duration of ventricular electrode implantation in group HPCSP was longer than that in group RVP(100.70±25.87 s vs 86.59±35.59 s,P<0.05);the operative ventricular impedance in RVP group was lower than that in HPCSP group(659.19 ± 148.62 Ωvs.732.62 ± 199.80 Ω,P<0.05).There was no significant difference in the data of ventricular perception,ventricular threshold,atrial perception,atrial threshold and atrial impedance between the two groups(P>0.05).During the 1-year follow-up,the ventricular perception in HPCSP group was significantly higher than that in RVP group(16.76±5.43 mv vs.12.96±5.28 mv,P<0.05),and the ventricular impedance in HPCSP group was lower than that in RVP group(519.89±68.46Ω vs.580.63±77.44Ω,P<0.05).(3)Comparison of follow-up results : Preoperative QRS duration had no significant difference between the two groups,but postoperatively QRS duration of RVP group was significantly wider than HPCSP group(170.37±15.74 ms vs.103.52±23.53 ms,P<0.05),and the difference of QRS duration before and after operation was also statistically significant between the two groupsa(57.41±43.43 ms vs-14.05±39.05 ms,P<0.05).The echocardiographic parameters showed that LVEF in group HPCSP was significantly higher than that in group RVP at 1 year follow-up(60.00±6.02% vs 57.13±6.00%,P<0.05).During the 1-year follow-up,there was no significant difference in postoperative complications between the two groups;However,the rehospitalization rate of RVP was significantly higher than HPCSP(36.5% vs 16.7%,P<0.05);during the 1-year follow-up,3 cases died in group RVP and 0 cases in group HPCSP,there was no difference between the two groups.CONCLUSIONS: 1.HPCSP can be safely and effectively used in patients with atrioventricular conduction;2.Compared with RVP,HPCSP has better efficacy and safety in the clinical treatment of patients with AV block,and can be used as a preferred regimen for clinical treatment.