The clinical utility of direct His-bundle pacing in patients with heart failure and permanent atrial fibrillation

Conduction system pacing: promoting the physiology to prevent heart failure

“…In a study, Molhoek et al patients with AF showed a milder degree of response to CRT compared to those with sinus rhythm. However, the long-term survival rate was comparable among these two groups of patients [ 36 , 37 ]. According to the guidelines, CRT should be performed in patients with HF and LVEF ≤ 35% with NYHA class III or IV if they are in AF and have intrinsic QRS ≥ 130 ms, provided a strategy to ensure biventricular capture is in place.…”

“…The MUSTIC AF trial is considered the first randomized trial showing potential benefits of CRT in HF patients with permanent AF by determining biventricular stimulation as a preferred mode compared to RV [ 41 ]. An observational study by Gasparini et al demonstrated that significant improvements in LVEF, the left ventricular end-systolic volume (LVESV), and exercise capacity were observed in AF patients who underwent AVJ ablation [ 37 , 38 ]. Deshmukh et al demonstrated further improvement in LV dimensions with His pacing in patients with impaired LV systolic function and AF prior to AV node ablation and achieved procedural success in 60% of cases [ 36 , 37 ].…”

“…At present with the development of dedicated tools for direct HBP, the success rate of implantations has become more than 90%. Moreover, in most cases, the acceptable pacing thresholds can be achieved [ 37 ]. Su et al evaluated the long-term performance of HBP following AV node ablation in patients with AF and HF.…”