Sex differences outcomes in conduction system pacing for patients with typical left bundle branch block

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-08-22 DOI:10.1016/j.ijcard.2024.132475

Shengjie Wu , Wenxuan Shang , Yang Ye , Lan Su , Songjie Wang , Mengxing Cai , Dingzhou Wang , Yanlei He , Rujie Zheng , Guosheng Fu , Weijian Huang

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Abstract

Background

Biventricular pacing (BVP) appears to confer more pronounced advantages in women, yet the impact of conduction system pacing (CSP) remains insufficiently characterized. This investigation seeks to elucidate sex-specific disparities in clinical outcomes among patients with typical left bundle branch block (LBBB) undergoing CSP, with a particular focus on assessing contributory factors.

Methods

Consecutive patients diagnosed with nonischemic cardiomyopathy, exhibiting left ventricular ejection fraction (LVEF) ≤ 40%, and manifesting typical LBBB as Strauss criteria, underwent CSP. Subsequent longitudinal monitoring assessed improvements in LVEF and the composite endpoint of mortality or heart failure hospitalization (HFH).

Results

Among the included 176 patients, women (n = 84, mean age: 69.5 ± 8.8 years) displayed smaller heart size (LVEDd, 62.0 ± 8.3 mm vs. 64.8 ± 7.9 mm, P = 0.023) and shorter baseline QRSd (163.5 ± 17.7 ms vs. 169.7 ± 15.1 ms; P = 0.013) than men. Of the 171 patients who completed the follow-up, super-response was observed in 120 (70%), with a higher occurrence in women than men (78.3% vs. 62.5%, P = 0.024). The incidence of death or HFH was numerically lower in women (7.1% Vs 13%, Log-rank P = 0.216). Notably, the super-response showed a significant difference in women compared to men at the same electrocardiography and/or echocardiographic parameters value. Mediation analysis between sex and super-response revealed that LVEDd and pQRSd play an intermediary role, with the mediation proportion of 26.07% and 27.98%, respectively.

Conclusions

Women may derive more benefits from CSP, and pQRSd and LVEDd partly drive this difference.

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典型左束支传导阻滞患者传导系统起搏的性别差异结果。

背景：双心室起搏（BVP）似乎在女性中具有更明显的优势，但传导系统起搏（CSP）的影响仍未得到充分描述。本研究旨在阐明接受 CSP 治疗的典型左束支传导阻滞（LBBB）患者在临床预后方面的性别差异，尤其侧重于评估促成因素：连续确诊为非缺血性心肌病、左室射血分数（LVEF）≤40%、符合斯特劳斯标准的典型左束支传导阻滞患者均接受了CSP治疗。随后的纵向监测评估了 LVEF 的改善情况以及死亡率或心衰住院率（HFH）的综合终点：在纳入的 176 名患者中，女性（n = 84，平均年龄：69.5 ± 8.8 岁）的心脏尺寸（LVEDd, 62.0 ± 8.3 mm vs. 64.8 ± 7.9 mm, P = 0.023）和基线 QRSd（163.5 ± 17.7 ms vs. 169.7 ± 15.1 ms; P = 0.013）均小于男性。在完成随访的 171 名患者中，120 人（70%）出现了超反应，女性的超反应发生率高于男性（78.3% vs. 62.5%，P = 0.024）。女性的死亡或高频血流发生率在数量上更低（7.1% 对 13%，Log-rank P = 0.216）。值得注意的是，在心电图和/或超声心动图参数值相同的情况下，女性的超级反应与男性相比有显著差异。性别与超反应之间的中介分析显示，LVEDd 和 pQRSd 起中介作用，中介比例分别为 26.07% 和 27.98%：女性可能从 CSP 中获得更多益处，而 pQRSd 和 LVEDd 是造成这种差异的部分原因。

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