Abstract
Introduction: Conduction System (His-Bundle, Left Bundle Branch) Pacing (CSP) for cardiac resynchronization therapy (CRT) provides more physiologic ventricular activation than right ventricular pacing. CSP has demonstrated improved outcomes in patients with cardiomyopathy. The effectiveness of CSP in patients with cancer or prior exposure to cardiotoxic agents is unknown. Methods: We retrospectively studied patients with cancer who underwent CSP for CRT from January 2018 to June 2021 at Rush University Medical Center. Changes in QRS duration, left ventricular ejection fraction (LVEF), B natriuretic peptide (BNP), and hospital admission rates pre- and post-initiating CSP were analyzed at baseline compared with one-year post CSP using student’s T-Tests. Results: Sixty-five patients with cancer underwent CSP, of which 11 had cardiomyopathy and underwent CSP for CRT. Five patients (45.5%) were female, 5 (45.5%) Caucasian, with mean age 71.2± 9.0 years. Non-Hodgkin Lymphoma (3 cases, 27.3%) was the most common cancer. Most (90.1%) patients had non-metastatic disease, 72.7% had prior chemotherapy, 54.5% were treated with cardiotoxic agents. Seven patients (63%) had a baseline left bundle branch block (LBBB). QRS duration shortened (122.3 ± 18.9 ms. vs. 153.7 ± 20.6 ms, p=0.003), LVEF increased (27.0 ± 6.2% vs. 39.0 ± 12.9 %, p=0.007), and BNP decreased (807.6 ± 1709.9 pg/ml vs. 591.4.0 ± 1079.4 pg/ml, p=0.78) (figure1). There was no change in heart failure hospitalizations (0.3 ± 0.48 admissions /person/year), at baseline vs. 1-year post-CSP. Conclusion: In this small population of patients with cancer and reduced LVEF with indications for CRT, CSP was associated with significant improvement in LVEF and QRS duration; and a non-significant decrease in BNP. The overall hospitalization rate was very low. Future studies in a larger population with a longer follow-up period are paramount to further assess this promising strategy.
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