Feasibility and Efficacy of His Bundle Pacing or Left Bundle Pacing Combined With Atrioventricular Node Ablation in Patients With Persistent Atrial Fibrillation and Implantable Cardioverter‐Defibrillator Therapy

Abstract

Background Persistent atrial fibrillation may lead to a higher probability of inappropriate shocks in heart failure patients with an implantable cardioverter‐defibrillator ( ICD ). The aim of this study was to evaluate the impact of His‐Purkinje conduction system pacing combined with atrioventricular node ablation in improving heart function and preventing inappropriate shock therapy in these patients. Methods and Results A total of 86 consecutive patients with persistent atrial fibrillation and heart failure who had indications for ICD implantation were enrolled from January 2010 to March 2018. His‐Purkinje conduction system pacing with ICD and atrioventricular node ablation was attempted in 55 patients, and the remaining patients underwent ICD implantation only. Left ventricular (LV) ejection fraction, LV end‐systolic volume, New York Heart Association ( NYHA ) classification, shock therapies, and drug therapy were assessed during follow‐up. Overall, 31 patients received ICD implantation with optimal drug therapy (group 1). atrioventricular node ablation combined with His‐Purkinje conduction system pacing was successfully achieved in 52 patients (group 2). During follow‐up, patients in group 2 had lower incidence of inappropriate shock (15.6% versus 0%, P <0.01) and adverse events ( P =0.011). Meanwhile, improvement in LV ejection fraction and reduction in LV end‐systolic volume were significantly higher in group 2 than in group 1 (15% versus 3%, P <0.001; and 40 versus 2 mL, P <0.01, respectively). NYHA functional class improved in both groups from a baseline 2.57±0.68 to 1.73±0.74 in group 1 and 2.73±0.59 to 1.42±0.53 in group 2 ( P <0.01). Conclusions His‐Purkinje conduction system pacing combined with atrioventricular node ablation is feasible and safe with a high success rate in persistent atrial fibrillation patients with heart failure and ICD indication. It can significantly reduce the incidence of inappropriate shocks and improve LV function.

Left bundle branch pacing guided by premature ventricular complexes during implant

“…Conduction system pacing combined with AV node ablation showed a high success rate in persistent atrial fibrillation patients with heart failure and implantable cardioverter-defibrillator indication. 10 This study also showed significant improvement in LV function and reduction in inappropriate shocks.…”

New‐onset intrinsic and paced QRS morphology of right bundle branch block pattern after atrioventricular nodal ablation: Longitudinal dissociation or anatomical bifurcation?

“…His‐Purkinje system conduction pacing combined with AVN ablation has become an established method of treating drug‐resistant supraventricular arrhythmias, especially in atrial fibrillation patients with heart failure who suffer from insufficient or intolerable medical therapy or failed AF catheter ablation to restore sinus rhythm 4‐7 . As reported previously, pacing in the distal His bundle or left bundle branch region allows for adequate space to safely perform AVN ablation 5,7 . We implanted the pacing lead immediately beyond the tricuspid valve, which was confirmed by contrast ejection though the sheath and echocardiography (Figure 1C).…”

Assessment of ventricular mechanical synchronization after left bundle branch pacing using 2‐D speckle tracking echocardiography

“…14,15 LBBP was also used in patients of atrioventricular node ablation with persistent atrial fibrillation and implantable cardioverter-defibrillator therapy in order to improve LV function. 16 In this study, we encountered an interesting case with atrial fibrillation, III AVB and symptoms of heart failure including dyspnea and decreased activity tolerance. After being upgraded to LBBP using a 3830 pacing lead, the patient's symptoms of heart failure alleviated, and the NYHA heart function class improved from class III to class II about 1 month after operation (Supplementary Figure S3).…”