Circulation journal : official journal of the Japanese Circulation Society · 2026
Long-Term Prognosis and Outcomes in Patients Undergoing His Bundle Pacing Implantation - A Multicenter, Prospective Observational Study in Japan.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Yanagisawa Satoshi, Kato Hiroyuki, Kanzaki Yasunori, Murase Yosuke, Fujita Masaya, Nakagomi Toshifumi, Ishikawa Shinji, Kamikubo Yosuke, Suzuki Hirohiko, Murakami Hisashi, Morishima Itsuro, Imai Hajime, Kaneko Shinji, Yoshida Yukihiko, Okumura Takahiro, Shibata Rei, Inden Yasuya, Murohara Toyoaki
Аннотация
BACKGROUND: His bundle (HB) pacing (HBP) can achieve an ideal pattern of ventricular activation. The long-term efficacy and clinical outcomes of HBP in Japan remain unclear.
METHODS AND RESULTS: This multicenter prospective observational study enrolled 115 patients undergoing HBP implantation at 8 experienced centers in Japan. Inclusion criteria comprised atrioventricular block or conduction disturbance and an anticipated ventricular pacing of ≥40% in patients scheduled for HBP implantation. All patients were followed for 3 years after implantation. The primary endpoints were all-cause mortality, hospitalization for heart failure, and upgrade to cardiac resynchronization therapy. Secondary endpoints were changes in echocardiographic parameters and laboratory biomarkers after implantation. Seventy-eight (68%) patients continued HBP after the procedure (procedural success), whereas 68 (59%) patients exhibited clinical success (HB capture threshold ≤2.5 V at 1.0 ms). Six months after implantation, echocardiographic parameters improved, and brain B-type natriuretic peptide (BNP) levels decreased substantially. Major adverse clinical events (MACE), defined as the composite of the primary endpoints, occurred in 16 (21%) patients; 18 (23%) patients discontinued HBP during the follow-up period. Multivariable analysis identified elevated BNP levels at baseline as an independent predictor of MACE.
CONCLUSIONS: HBP implantation presents technical challenges and exhibits a moderate success rate in real-world clinical practice. The high incidence of elevated HB capture thresholds and HBP abandonment mean that careful patient selection and rigorous long-term surveillance are required.
METHODS AND RESULTS: This multicenter prospective observational study enrolled 115 patients undergoing HBP implantation at 8 experienced centers in Japan. Inclusion criteria comprised atrioventricular block or conduction disturbance and an anticipated ventricular pacing of ≥40% in patients scheduled for HBP implantation. All patients were followed for 3 years after implantation. The primary endpoints were all-cause mortality, hospitalization for heart failure, and upgrade to cardiac resynchronization therapy. Secondary endpoints were changes in echocardiographic parameters and laboratory biomarkers after implantation. Seventy-eight (68%) patients continued HBP after the procedure (procedural success), whereas 68 (59%) patients exhibited clinical success (HB capture threshold ≤2.5 V at 1.0 ms). Six months after implantation, echocardiographic parameters improved, and brain B-type natriuretic peptide (BNP) levels decreased substantially. Major adverse clinical events (MACE), defined as the composite of the primary endpoints, occurred in 16 (21%) patients; 18 (23%) patients discontinued HBP during the follow-up period. Multivariable analysis identified elevated BNP levels at baseline as an independent predictor of MACE.
CONCLUSIONS: HBP implantation presents technical challenges and exhibits a moderate success rate in real-world clinical practice. The high incidence of elevated HB capture thresholds and HBP abandonment mean that careful patient selection and rigorous long-term surveillance are required.