Clinical Outcomes of Conduction System Pacing vs Right Ventricular Septal Pacing in Atrioventricular Block: The CSPACE Randomized Controlled Trial
Abstract
BACKGROUND
Patients with atrioventricular (AV) block receiving right ventricular (RV) pacing are at risk of pacing-induced cardiomyopathy (PICM), need for upgrade to biventricular cardiac resynchronization therapy (CRT), heart failure hospitalization (HFH), and mortality. Conduction system pacing (CSP) is a promising pacing strategy to mitigate these adverse outcomes.
OBJECTIVES
The aim of this study was to compare the clinical outcomes between RV septal pacing (RVsP) and CSP.
METHODS
A randomized controlled trial (RCT) was performed in 202 consecutive patients with pacing indication for AV block without CRT indication, with a 1:1 randomization allocation ratio between RVsP and CSP. The primary outcome was a composite endpoint of PICM, upgrade to biventricular CRT, HFH, and all-cause mortality. This trial was registered with the Australian New Zealand Clinical Trials Registry.
RESULTS
CSP was successful in 89 of 101 patients (88.1%). After a mean follow-up period of 25.2 ± 11.8 months, CSP was associated with lower composite endpoint (7.17 vs 20.69 events per 100 person-years; HR: 0.35; 95% CI: 0.19-0.64; P < 0.001) primarily driven by lower PICM (CSP 4.58 vs RVsP 14.69 events per 100-person-years; HR: 0.31; 95% CI: 0.15-0.67; P = 0.002) and need for CRT upgrade (0 vs 1.92 events per 100-person-years; HR: 1.65e-9; 95% CI: 0-∞; P = 0.043). There was no difference in HFH (CSP 0.48 vs RVsP 2.92 events per 100-person years; HR: 0.16; 95% CI: 0.02-1.37, P = 0.057) or all-cause…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 202 participants or records.
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