Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure

Abstract

Aims His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation has been demonstrated to be effective in patients with atrial fibrillation (AF) and heart failure (HF) during medium-term follow-up and there are limited data on the risk analysis of adverse prognosis in this population. In this study, we aimed to evaluate the long-term performance of HBP following AVN ablation in AF and HF. Methods and results From August 2012 to December 2017, consecutive AF patients with HF and narrow QRS who underwent AVN ablation and HBP were enrolled. The clinical and echocardiographic data, pacing parameters, all-cause mortality, and heart failure hospitalization (HFH) were tracked. A total of 94 patients were enrolled (age 70.1 ± 10.5 years; male 57.4%). Acute HBP were achieved in 89 (94.7%) patients with successful permanent HBP combined with AVN ablation in 81 (86.2%) patients. Left ventricular ejection fraction (LVEF) improved from 44.9 ± 14.9% at baseline to 57.6 ± 12.5% during a median follow-up of 3.0 (IQR: 2.0–4.4) years (P < 0.001). Heart failure hospitalization or all-cause mortality occurred in 21 (25.9%) patients. The LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥40 mmHg, or serum creatinine (Scr) ≥97 μmol/L at baseline was significantly associated with higher composite endpoint of HFH or death (P < 0.05). The His capture threshold was 1.0 ± 0.7 V/0.5 ms at implant and remained stable during follow-up. Conclusion His-bundle pacing combined with AVN ablation was effective in patients with AF and drug-refectory HF. High PASP, high Scr, or low LVEF at baseline was independent predictors of composite endpoint of all-cause mortality or HFH.

Brady‐arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his‐bundle pacing superior to biventricular pacing？

“…What will help these ventricular‐pacing dependant patients with AF and HFrEF? His‐Purkinje system pacing, including His‐bundle pacing (HBP) and left branch bundle pacing (LBBP), were the alternative procedures in patients with indications of bradycardia and heart failure 5–6 . However, very few studies talk about the impact of HBP on these patients compared with BVP.…”

His‐purkinje conduction system pacing in atrial fibrillation and heart failure: A virtual dream coming true

“…Previous studies 4–8 have confirmed the feasibility and efficacy of HPCSP in patients with AF and AVN ablation. These studies demonstrated that permanent HBP with AVN ablation leads to significant improvement in cardiac function in AF patients with narrow QRS who suffered from HF with preserved or reduced ejection fraction.…”

“…In patients with LBBB undergoing BVP, left ventricular pacing fused with intrinsic ventricular activation have been shown to improve outcomes. But in patients with AF and AVN ablation, this fusion with intrinsic activation is not possible 6 …”

How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls

“…[ 22 ] In another study of 94 patients undergoing AV node ablation, HBP was successful in 86% of patients with an improvement in LV ejection fraction (from 44.9 ± 14.9% [mean ± standard deviation] at baseline to 57.6 ± 12.5% after a median follow-up of 3.0 years). [ 23 ] The efficacy of HBP may be uncertain in patients with intraventricular conduction delay, significant LV scar and in 10–30% of LBBB patients in whom the site of block may be distal to the HB.…”