Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE‐HF randomized controlled trial

Keene, D. et al. (2024) Predictors of the efficacy of His bundle pacing in patients with a prolonged PR interval: A stratified analysis of the HOPE‐HF randomized controlled trial. European Journal of Heart Failure, 26(10), pp. 2261-2268. (doi: 10.1002/ejhf.3367) (PMID:39023285)

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Abstract

Aims: The randomized, double‐blind, placebo‐controlled HOPE‐HF trial assessed the benefit of atrio‐ventricular (AV) delay optimization delivered using His bundle pacing. It recruited patients with left ventricular ejection fraction ≤40%, PR interval ≥200 ms, and baseline QRS ≤140 ms or right bundle branch block. Overall, there was no significant increase in peak oxygen uptake (VO2max) but there was significant improvement in heart failure specific quality of life. In this pre‐specified secondary analysis, we evaluated the impact of baseline PR interval, echocardiographic E‐A fusion, and the magnitude of acute high‐precision haemodynamic response to pacing, on outcomes. Methods and results: All 167 randomized participants underwent measurement of PR interval, acute haemodynamic response at optimized AV delay, and assessment of presence of E‐A fusion. We tested the impact of these baseline parameters using a Bayesian ordinal model on VO2max, quality of life and activity measures. There was strong evidence of a beneficial interaction between the baseline acute haemodynamic response and the blinded benefit of pacing for VO2 (Pr 99.9%), Minnesota Living With Heart Failure (MLWHF) (Pr 99.8%), MLWHF physical limitation score (Pr 98.9%), EQ‐5D visual analogue scale (Pr 99.6%), and exercise time (Pr 99.4%). The baseline PR interval and the presence of baseline E‐A fusion did not have this reliable ability to predict the clinical benefit of pacing over placebo across multiple endpoints. Conclusions: In the HOPE‐HF trial, the acute haemodynamic response to pacing reliably identified patients who obtained clinical benefit. Patients with a long PR interval (≥200 ms) and left ventricular impairment who obtained acute haemodynamic improvement with AV‐optimized His bundle pacing were likely to obtain clinical benefit, consistent across multiple endpoints. Importantly, this gradation can be reliably tested for before randomization, but does require high‐precision AV‐optimized haemodynamic assessment to be performed.

Item Type:Articles
Keywords:Conduction system pacing, His bundle pacing, physiological pacing, haemodynamic study, atrio‐ventricular delay optimization.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Keene, D., Kaza, N., Srinivasan, D., Ali, N., Tanner, M., Foley, P., Chandrasekaran, B., Moore, P., Adhya, S., Qureshi, N., Muthumala, A., Lane, R., Rinaldi, A., Agarwal, S., Leyva, F., Behar, J., Bassi, S., Ng, A., Scott, P., Prasad, R., Swinburn, J., Tomson, J., Sethi, A., Shah, J., Lim, P. B., Kyriacou, A., Thomas, D., Chuen, J., Kamdar, R., Kanagaratnam, P., Mariveles, M., Johnson, N., Falaschetti, E., Howard, J. P., Arnold, A., Cleland, J. G.F., Francis, D. P., Whinnett, Z., and Shun‐Shin, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:18 July 2024
Copyright Holders:Copyright © 2024 The Authors
First Published:First published in European Journal of Heart Failure 26(10): 2261-2268
Publisher Policy:Reproduced under a Creative Commons licence

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