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Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation

Lan Su1,2, Mengxing Cai1,2, Shengjie Wu1,2

  • 1Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, China.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|December 28, 2020
PubMed

Insights

His-bundle pacing (HBP) with AVN ablation improves heart function in atrial fibrillation (AF) and heart failure (HF) patients. Baseline low LVEF, high PASP, or high Scr predict adverse outcomes, guiding risk stratification.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) and heart failure (HF) often coexist, posing significant management challenges.
  • His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation shows promise for improving outcomes in this patient group.
  • Long-term risk analysis of HBP following AVN ablation in AF and HF patients requires further investigation.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of His-bundle pacing (HBP) after atrioventricular node (AVN) ablation in patients with atrial fibrillation (AF) and heart failure (HF).
  • To identify predictors of adverse prognosis, including mortality and heart failure hospitalization (HFH), in this population.

Main Methods:

  • A prospective study enrolled 94 patients with AF and HF undergoing AVN ablation and HBP.
  • Clinical, echocardiographic, and pacing parameters were tracked.
  • Outcomes included all-cause mortality, HFH, and changes in left ventricular ejection fraction (LVEF).

Main Results:

  • Successful permanent HBP with AVN ablation was achieved in 86.2% of patients.
  • LVEF significantly improved from baseline (44.9%) to follow-up (57.6%) (P < 0.001).
  • The composite endpoint of HFH or all-cause mortality occurred in 25.9% of patients. Baseline LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥ 40 mmHg, or serum creatinine (Scr) ≥ 97 μmol/L were significant predictors (P < 0.05).

Conclusions:

  • His-bundle pacing combined with AVN ablation is an effective strategy for patients with AF and drug-refractory HF.
  • Baseline high PASP, high Scr, or low LVEF are independent predictors of adverse outcomes (mortality or HFH).
  • HBP offers a viable pacing option with stable parameters during long-term follow-up.
Abstract

Keywords:
Atrial fibrillationAtrioventricular node ablationHeart failureHis-bundle pacing

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