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HISPACE: A Randomised Controlled Trial Comparing His-Bundle Pacing with Conventional Dual Chamber Pacemakers

Dr Chee Loong Chow, Institution: University of Melbourne

2019 Health Professional Scholarship

Years funded: 2020-2022


Pacemakers are key in the management of cardiac conduction problems. Conventional pacemakers provide pacing support via the right ventricle (RV). Chronic RV pacing have been associated with heart failure, cardiac rhythm abnormalities, and stroke. Furthermore, a proportion of these patients who develop heart failure from the pacemaker may require an upgrade procedure to a biventricular device to improve symptoms, adding to the existing healthcare burden. Most recently, permanent His-bundle pacing (HBP) is gaining spotlight owing to its superior physiological benefits over conventional pacing methods.

Recently, a key observational study demonstrated that HBP conferred lower mortality, hospitalisation rates for heart failure, and need for upgrade to biventricular device, compared to RV pacing. This observation illustrates the potential of HBP to supersede conventional RV pacemakers altogether into the future. From an economic standpoint, based on statistics from Australian Bureau of Statistics, roughly 10,000 pacemakers were implanted in Australia last year. Up to 20% of these patients will develop heart failure, attracting significant cost to the health system, not just in loss of workforce productivity, but also in the form of hospitalisations. HBP could obviate the risk of heart failure altogether.

 Furthermore, roughly 1% of these heart failure patients require an upgrade to a biventricular device for their symptoms. As each device upgrade comes at roughly the cost of $12,000 + $1,500 implanter service fee, HBP could save a potential $1.35 million every year, by obviating the need for this upgrade. So far, only observational data is available, and good quality randomised controlled data is direly required. Therefore this project aims to compare HBP to conventional dual chamber pacemaker, assessing for all-cause mortality, hospitalisation rate for heart failure (HFH), left ventricular ejection fraction (LVEF), and need for upgrade to biventricular pacing systems.

This project is co-funded with NHMRC - National Health and Medical Research Council.

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