Feasibility of Left Bundle Branch Area Pacing Combined with Atrioventricular Node Ablation in Atrial Fibrillation Patients with Heart Failure

Abstract

Background: Pacemaker implantation combined with atrioventricular node ablation (AVNA) could be a practical choice for atrial fibrillation (AF) patients with heart failure (HF). Left bundle branch area pacing (LBBaP) has been widely reported. Objectives: To explore the safety and efficacy of LBBaP combined with AVNA in AF patients with HF. Methods and results: Fifty-six AF patients with HF attempted LBBaP and AVNA from January 2019 to December 2020. Standard LBBaP was achieved in forty-six patients, and another ten received left ventricular septal pacing (LVSP). The cardiac function indexes and pacemaker parameters were evaluated at baseline, and we conducted a 1-month and 1-year follow-up. Result: At the time of implantation and 1-month and 1-year follow-up, QRS duration of LVSP group was longer than that of LBBaP group. The pacemaker parameters remained stable in both the LBBaP and LVSP groups. At 1-month and 1-year follow-up after LBBaP and AVNA, left ventricular ejection fraction, left ventricular end-diastolic diameter, and NYHA classification continued to improve. Baseline left ventricular ejection fraction and QRS duration change at implantation can predict the magnitude of improvement of left ventricular ejection fraction at 1-year after LBBaP. Baseline right atrial left-right diameter, the degree of tricuspid regurgitation, and interventricular septum thickness may be the factors affecting the success of LBBaP. Conclusion: LBBaP combined with AVNA is safe and effective for patients with AF and HF. Baseline right atrial left-right diameter, the degree of tricuspid regurgitation, and interventricular septum thickness may be the factors affecting the success of LBBaP.

Outcomes of combined left bundle branch area pacing with atrioventricular nodal ablation in patients with atrial fibrillation and pulmonary disease

“…While the efficacy of the combined LBBAP with AV node ablation in patients with poorly controlled atrial fibrillation has previously been demonstrated, 25,26 there is a paucity of data regarding its efficacy in patients with underlying advance respiratory disease. In patients with pulmonary hypertension, the presence and persistence of atrial fibrillation is associated with increased mortality 13,27,28 .…”

Clinical outcomes of left bundle branch area pacing: Prognosis and specific applications

“…was stopped with a compression bandage, and the hematoma resolved spontaneously. 51 Another study involving 25 patients (aged, 79.2 ± 4.2 years) who underwent successful LBBAP and AVNA reported no major complications related to the single-procedure approach. Additionally, pacing parameters remained stable during a median follow-up period of 81 days.…”

“…The LVEF, left ventricular end‐diastolic diameter, and NYHA classification continued to improve at 1‐month and 1‐year follow‐ups after combining LBBAP with AVNA. A pocket hematoma occurred in one patient operated with LBBAP and bleeding was stopped with a compression bandage, and the hematoma resolved spontaneously 51 . Another study involving 25 patients (aged, 79.2 ± 4.2 years) who underwent successful LBBAP and AVNA reported no major complications related to the single‐procedure approach.…”

Advances in Left Bundle Branch Pacing: Definition, Evaluation, and Applications

“…Several studies have examined small samples of patients who underwent LBBP after AVNA [18,34,69]. Jin atrial diameter, status of tricuspid regurgitation, and thickness of IVS may be associated with the success rate of LBBAP [70]. Pillai et al have compared outcomes between HBP and LBBP in patients undergoing AVNA [71].…”