Related Experiment Video

Updated: Aug 16, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with

Corentin Chaumont1, Nathanael Auquier2, Antoine Milhem3

  • 1Department of Cardiology, Rouen University Hospital, Rouen, France; FHU REMOD-VHF, UNIROUEN, INSERM U1096, Rouen, France.

Heart Rhythm
|December 22, 2022
PubMed

Insights

His-bundle pacing (HBP) combined with atrioventricular nodal ablation (AVNA) is a feasible and effective treatment for uncontrolled atrial arrhythmias. This approach preserves physiological activation and improves patient outcomes, with lead placement crucial for success.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • His-bundle pacing (HBP) offers physiological ventricular activation, an advantage over traditional right ventricular pacing.
  • Limited data exist on the combination of HBP and atrioventricular nodal ablation (AVNA).

Purpose of the Study:

  • To evaluate the feasibility and efficacy of AVNA combined with HBP in patients with uncontrolled atrial arrhythmias.
  • To provide further evidence supporting this therapeutic strategy.

Main Methods:

  • Prospective study of 75 patients undergoing AVNA after HBP implantation across three hospitals (2017-2022).
  • Assessment of AVNA success rates (complete block or rate control) and His-bundle (HB) lead performance.
  • Evaluation of lead stability and HB capture thresholds post-procedure.

Main Results:

  • Successful AVNA achieved in 77% (complete block) and 16% (rate control) of patients.
  • No lead dislodgments occurred; acute HB capture threshold increases were transient in most cases.
  • Significant improvements observed in New York Heart Association functional class and left ventricular ejection fraction.

Conclusions:

  • AVNA combined with HBP is a feasible and clinically effective treatment for uncontrolled atrial arrhythmias.
  • Optimal HB lead placement, avoiding atrial signal recording, can enhance AVNA success.
Abstract

Keywords:
ArrhythmiaAtrial fibrillationAtrioventricular nodal ablationHis-bundle pacingRate control

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