{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:21:31Z","timestamp":1791883291664,"version":"4.3.4"},"reference-count":41,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Romanian Society of Cardiology Training Scholarship","award":["235\/13 August 2024"],"award-info":[{"award-number":["235\/13 August 2024"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pacemaker-induced cardiomyopathy (PICM) develops in up to 30% of patients with chronic right ventricular pacing. While biventricular (BIV) upgrade is the conventional strategy, conduction system pacing (CSP) offers a physiologic alternative recently endorsed by the 2025 ESC\/EHRA Consensus Statement. However, comparative evidence in PICM is limited. Therefore, we aimed to compare outcomes of PICM patients undergoing CSP versus BIV upgrade. Methods: This retrospective analysis included consecutive PICM patients who were upgraded to CSP or BIV between 2022 and 2024 at a single, experienced center. Follow-up averaged &gt;19 months. Clinical outcomes, lead performance, echocardiographic parameters, complications, and quality of life (QoL) were evaluated. Results: Sixty-three patients were included (CSP: 26; BIV: 37). Mean age and sex distribution were similar; both groups had wide paced QRS complexes and a high ventricular pacing burden. Baseline left ventricular ejection fraction (LVEF) was lower in BIV patients (29 \u00b1 7% vs. 35 \u00b1 6%, p = 0.01). Procedure duration was comparable, but fluoroscopy was shorter with CSP. QRS duration narrowed significantly in both groups (CSP: 163 \u00b1 28\u2192132 \u00b1 12 ms; BIV: 171 \u00b1 23\u2192140 \u00b1 18 ms; both p &lt; 0.05). During follow-up, LVEF improved (CSP: 41 \u00b1 8%; p = 0.008; BIV: 39 \u00b1 8%, p = 0.0001), as did NYHA class, with no significant intergroup differences. The rates of heart failure hospitalization, all-cause mortality, and QoL were similar. Notably, 34.6% of CSP patients retained their existing generator, suggesting procedural and economic benefits. Conclusions: CSP is a feasible and potentially cost-efficient alternative to BIV upgrade in PICM, with comparable improvements in ventricular function, symptoms, and clinical outcomes. Larger prospective trials are warranted.<\/jats:p>","DOI":"10.3390\/jcm14217745","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:21:46Z","timestamp":1762194106000},"page":"7745","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparing Conduction System Pacing to Biventricular Upgrade in Pacemaker-Induced Cardiomyopathy: A Retrospective Observational Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0422-0315","authenticated-orcid":false,"given":"Bernadett Miriam","family":"Dobai","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9103-5396","authenticated-orcid":false,"given":"Bal\u00e1zs","family":"Polg\u00e1r","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8769-7153","authenticated-orcid":false,"given":"M\u00e1rk","family":"G\u00e9mesi","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"},{"name":"Doctoral College, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4219-044X","authenticated-orcid":false,"given":"Manuella","family":"Bogdan","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1158-8554","authenticated-orcid":false,"given":"Nikolett","family":"Vigh","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0315-5502","authenticated-orcid":false,"given":"Mirjam","family":"Tur\u00e1ni","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1286-6576","authenticated-orcid":false,"given":"G\u00e1bor Zolt\u00e1n","family":"Duray","sequence":"additional","affiliation":[{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"},{"name":"Heart and Vascular Center, Semmelweis University, 1124 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1059-0249","authenticated-orcid":false,"given":"P\u00e9ter","family":"B\u00f3gyi","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Central Hospital of Northern Pest\u2014Military Hospital, 1134 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/j.1540-8159.2011.03150.x","article-title":"The 11th world survey of cardiac pacing and implantable cardioverter-defibrillators: Calendar year 2009\u2014A World Society of Arrhythmia\u2019s Project","volume":"34","author":"Mond","year":"2011","journal-title":"Pacing Clin. 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O2"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7745\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:39:55Z","timestamp":1762195195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":41,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217745"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217745","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}