(P099) CARDIAC RESYNCHRONISATION AND LEFT VENTRICULAR EJECTION FRACTION IMPROVEMENT WITH SINGLE VENTRICULAR PHYSIOLOGICAL PACING LEAD

Background:

Background: His pacing (His-P) and left bundle branch area pacing (LBB-P) are new modalities to obtain physiologic pacing (PP) and normal to near normal cardiac synchrony; they often obtain shorter QRS durations and they could replace the need of Bi-V (CRT) implants if LVEF improves as much with less leads implanted.

METHODS AND RESULTS: From our cohort of 211 physiologic pacing attempts (2019-2022), we extracted all patients (pts) with available ultrasounds before and after implants, aiming to describe the variation of Left Ventricular Ejection Fraction (LVEF) over time; all attempts, including failures were analyzed. A total of 87 pts completed follow-up LVEF evaluation. Pts were 36,8% females; median age was 79 +/- 8.5 years. Indications were: SSS 25%, AV block 41% (including 8 post TAVR), Pacemaker induced cardiomyopathy (PIMC) 27% and AV node ablation in 7%. Success to achieve cardiac resynchronisation (defined as a QRS shorter than 140ms and a LVAT shorter than 90ms, or 20% reduction in QRS width) was obtained in 82,6% of pts (higher success rate achieved with LBB-P: 88,4% vs 55,5% for His-P). Procedural time (pts in-out) was 88min (+/- 37min). Pts with a QRS larger than 150ms (CRT indication) accounted for 44% of the cohort. Mean QRS duration was 141,9ms (+/-36) pre-implant and 129,3ms (+/- 19) post implant. Mean LVEF was 43,7% (+/- 14) before implant and increased to 49,1% (+-/12) post implant for the entire cohort, in pts with CRT indication, variation persisted: mean LVEF improved from 37,3 to 44,1% and QRS duration from 172,9 to 136,8ms. Pts with less than 50% LVEF had a response rate of 75,5% (increase in LVEF from 4-30%), and 30% of patients increase their LEVF between 10-30% (deemed super responders), only one pt decrease 10% her LVEF (a His failure implant).

Conclusion:

Conclusion: Cardiac resynchronisation is feasible with less leads needed, potentially with longer duration of batteries and lesser cost for the health system. Response rate is similar to CRT historical controls but super responders are twice to three times higher tan historical controls.