His-Purkinje conduction system pacing and atrioventricular node ablation.
Amal Muthumala1, Pugazhendhi Vijayaraman2
1North Middlesex University Hospital and St Bartholomew's Hospital, London, UK.
Herzschrittmachertherapie & Elektrophysiologie
|May 8, 2020
Summary
His-Purkinje conduction system pacing (HPCSP) offers normal ventricular activation, preventing adverse effects. This technique shows promise for atrioventricular node ablation in atrial fibrillation patients, though larger trials are needed.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Right ventricular pacing can lead to adverse consequences due to abnormal ventricular activation.
- His-Purkinje conduction system pacing (HPCSP), including His bundle pacing (HBP) and left bundle branch pacing (LBBP), enables physiological ventricular activation.
- Atrioventricular (AV) node ablation is a treatment option for refractory atrial fibrillation, but often requires permanent pacing.
Purpose of the Study:
- To evaluate the efficacy and safety of His-Purkinje conduction system pacing (HPCSP) in patients undergoing AV node ablation for atrial fibrillation.
- To explore the potential of HPCSP as a primary pacing modality post-AV node ablation.
Main Methods:
- Literature review of six studies detailing the experience of His bundle pacing in patients requiring AV node ablation.
- Analysis of reported outcomes and pacing parameters for His bundle pacing and left bundle branch pacing.
- Inclusion of findings from a recent observational study comparing LBBP outcomes in patients with left ventricular dysfunction and atrial fibrillation.
Main Results:
- Existing studies on His bundle pacing for AV node ablation show generally positive results, favoring this technique.
- Left bundle branch pacing demonstrates potential advantages, including better pacing parameters and a lower risk of threshold changes post-ablation.
- An observational study indicated superior outcomes with LBBP in a small cohort of patients with left ventricular dysfunction and atrial fibrillation undergoing AV node ablation.
Conclusions:
- His-Purkinje conduction system pacing is a promising alternative to conventional pacing after AV node ablation for atrial fibrillation.
- Left bundle branch pacing may offer superior results compared to His bundle pacing in specific patient populations.
- Large-scale, randomized clinical trials are necessary to confirm the long-term efficacy and superiority of HPCSP in this context.
Keywords:
AV node ablationAtrial fibrillationHis bundle pacingHis-Purkinje systemLeft bundle branch pacingMore Related Videos
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