The Role of High-output His-bundle Pacing During Atrioventricular Node Ablation

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrioventricular (AV) junction ablation (AVJA) effectively controls heart rate in atrial fibrillation (AF).
• A subset of patients presents technical challenges for standard right-sided AVJA.
• His-bundle pacing can assist in localizing the AV junction in difficult cases.

Purpose of the Study:

• To report a case series of patients with difficult-to-ablate AVJA.
• To present troubleshooting strategies for challenging AVJA procedures.
• To evaluate the utility of high-output His-bundle pacing in AVJA.

Main Methods:

• Case series of patients undergoing AVJA with challenging anatomy or pacing parameters.
• Utilized high-output His-bundle pacing to localize the AV junction.
• Assessed His capture from the right-sided approach to predict ablation strategy.

Main Results:

• High-output His pacing proved effective in localizing the AV junction for ablation.
• Inability to achieve His capture from the right side predicted standard approach failure.
• This finding indicated a need for a left-sided ablation approach.

Conclusions:

• High-output His-bundle pacing is a valuable tool for difficult AVJA.
• Right-sided His capture failure is a predictor for requiring a left-sided ablation strategy.
• These strategies can improve procedural success in complex AF rate control cases.