{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T05:55:10Z","timestamp":1763358910924,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to evaluate the feasibility and outcomes of conduction system pacing (CSP) in patients with heart failure (HF) who had a severely reduced left ventricular ejection fraction (LVEF) of less than 30% (HFsrEF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2018 and December 2020, all consecutive HF patients with LVEF\u2009&amp;lt;\u200930% who underwent CSP at our center were evaluated. Clinical outcomes and echocardiographic data [LVEF and left ventricular end-systolic volume (LVESV)], and complications were all recorded. In addition, clinical and echocardiographic (\u22655% improvement in LVEF or \u226515% decrease in LVESV) responses were assessed. The patients were classified into a complete left bundle branch block (CLBBB) morphology group and a non-CLBBB morphology group according to the baseline QRS configuration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy patients (66\u2009\u00b1\u20098.84 years; 55.7% male) with a mean LVEF of 23.2\u2009\u00b1\u20093.23%, LVEDd of 67.33\u2009\u00b1\u20097.47\u2005mm and LVESV of 212.08\u2009\u00b1\u200939.74\u2005ml were included. QRS configuration at baseline was CLBBB in 67.1% (47\/70) of patients and non-CLBBB in 32.9%. At implantation, the CSP threshold was 0.6\u2009\u00b1\u20090.3\u2005V @ 0.4\u2005ms and remained stable during a mean follow-up of 23.43\u2009\u00b1\u200911.44 months. CSP resulted in significant LVEF improvement from 23.2\u2009\u00b1\u20093.23% to 34.93\u2009\u00b1\u200910.34% (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001) and significant QRS narrowing from 154.99\u2009\u00b1\u200934.42 to 130.81\u2009\u00b1\u200925.18\u2005ms (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.001). Clinical and echocardiographic responses were observed in 91.4% (64\/70) and 77.1% (54\/70) of patients. Super-response to CSP (\u226515% improvement in LVEF or \u226530% decrease in LVESV) was observed in 52.9% (37\/70) of patients. One patient died due to acute HF and following severe metabolic disorders. Baseline BNP (odds ratio: 0.969; 95% confidence interval: 0.939\u20130.989; <jats:italic>P<\/jats:italic>\u2009=\u20090.045) was associated with echocardiographic response. The proportions of clinical and echocardiographic responses in the CLBBB group were higher than those in the non-CLBBB group but without significant statistical differences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CSP is feasible and safe in patients with HFsrEF. CSP is associated with a significant improvement in clinical and echocardiographic outcomes, even for patients with non-CLBBB widened QRS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1187169","type":"journal-article","created":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T04:54:43Z","timestamp":1684731283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The feasibility and safety of his-purkinje conduction system pacing in patients with heart failure with severely reduced ejection 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