Therapeutic Effect of His-Purkinje System Pacing Proportion on Persistent Atrial Fibrillation Patients With Heart Failure

Abstract

BackgroundHis-Purkinje system pacing (HPSP) combined with atrioventricular node ablation is an effective therapy for atrial fibrillation (AF) patients with heart failure (HF). However, atrioventricular node ablation has some limitations and disadvantages. HPSP combined with β -blockers reduces intrinsic heart rate and increases pacing proportion, which may be an alternative to HPSP combined with atrioventricular node ablation. This study was to assess the therapeutic effect of different HPSP proportion on AF patients with HF.MethodsThe study enrolled 30 consecutive persistent AF patients with HF who underwent HPSP. Heart rate was controlled by medical therapy. NYHA class, NT-proBNP, echocardiographic parameters were assessed at follow-up. MACE was defined as the composite endpoint of readmission for HF and cardiac mortality.ResultsThe AUC of pacing proportion for predicting MACE was 0.830 (SE = 0.140, 95%CI:0.649–0.941, p = 0.018), the optimal cut-off point of pacing proportion to predict MACE by ROC analysis was 71% (sensitivity:83.3%, specificity: 91.7%). In high pacing proportion group (>71%), there were significant improvements of NYHA class, NT-proBNP, LVEF and LVEDD from the baseline in wide QRS complex (QRSd>120 ms) patients and HFrEF patients at half year follow-up, and there were significant improvements in NYHA class, NT-proBNP from baseline in narrow QRS complex (QRSd ≤ 120 ms) patients and HFpEF patients at half year follow-up, moderate but no significant improvements of LVEF and LVEDD were observed in these patients. In low pacing proportion group (≤ 71%), there were no significant improvements of NT-proBNP, LVEDD or LVEF regardless of baseline QRS duration or LVEF (p > 0.05).ConclusionHigh pacing proportion (>71%) of HPSP can improve clinical outcomes and echocardiographic parameters in persistent AF patients with wide QRS complex or HFrEF, and clinical outcomes in persistent AF patients with narrow QRS complex or HFpEF. High pacing proportion of HPSP has a beneficial effect on the prognosis of persistent AF patients with HF.