Biventricular Versus His Bundle Pacing After Atrioventricular Node Ablation in Heart Failure Patients With Narrow QRS

Abstract

Background His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. Our goal was to compare short-term results of both pacing approaches in ventricular rate refractory atrial fibrillation (AF) patients who underwent atrioventricular node ablation (AVNA).Methods Consecutive symptomatic AF patients with moderately reduced left ventricular (LV) ejection fraction (EF ≥35% and <50%) and narrow QRS (≤120ms) who received HBP in conjunction with AVNA were compared to historical BiV pacing controls. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed. Results Among 24 patients (age 68.8 ± 6.5 years, 50% female, EF 39.6 ± 4%, QRS 95 ± 10ms) who underwent AVNA, 12 received BiV pacing and 12 HBP. Both pacing modalities had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of post-implant QRS duration, implantation fluoroscopy times, reduction of LV volumes (EDV 127 (86 – 150) ml vs. 146 (121 – 190) ml, P = 0.101; ESV 64 (46 – 81) ml vs. 90 (75 – 123) ml, P = 0.008) and increase in LVEF (46 (41 – 55) % vs. 38 (35 – 42) %, P = 0.005). However, improvement of the New York Heart Association class was similar in both groups.Conclusions In ventricular rate refractory AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both “ablate and pace” strategies.