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Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with

Maja Ivanovski1,2, Miha Mrak1, Anja Zupan Mežnar1

  • 1Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.

Journal of Cardiovascular Development and Disease
|July 25, 2022
PubMed

Insights

Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), offers better outcomes than biventricular (BiV) pacing for heart failure patients undergoing atrioventricular node ablation. CSP improved symptoms and heart function, with LBBP showing stable pacing potential.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Conduction system pacing (CSP) modalities like His-bundle pacing (HBP) and left bundle branch pacing (LBBP) are emerging alternatives to biventricular (BiV) pacing.
  • These techniques are considered for heart failure (HF) patients requiring a pace and ablate strategy, particularly those with refractory atrial fibrillation (AF).

Purpose of the Study:

  • To compare the clinical outcomes of HF patients with refractory AF who received either BiV pacing or CSP (HBP or LBBP) following atrioventricular node ablation (AVNA).

Main Methods:

  • A retrospective analysis of 50 consecutive HF patients undergoing AVNA was performed.
  • Patients were divided into three groups: BiV pacing (13 patients), HBP (27 patients), and LBBP (10 patients).
  • Clinical outcomes including New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF) were assessed post-procedure.

Main Results:

  • While baseline characteristics and acute success rates were similar, CSP modalities demonstrated superior outcomes.
  • NYHA class improved significantly in HBP and LBBP groups but not in the BiV group.
  • LVEF increased significantly in HBP and LBBP groups, whereas it remained unchanged in the BiV group.

Conclusions:

  • Conduction system pacing (CSP) modalities provide superior symptomatic and echocardiographic improvements compared to BiV pacing after AVNA in HF patients.
  • Left bundle branch pacing (LBBP) may offer a more feasible pacing option due to its stable pacing parameters compared to HBP.

Keywords:
AV node ablationatrial fibrillationbiventricular pacingconduction system pacingheart failurehis bundle pacingleft bundle branch pacing

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