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A conversion CRT strategy combined with AVJA may be a perspective alternative for heart failure patients with

Mengna Chen1, Zhiqiang Dong2, Yimin Zhang1

  • 1The First Hospital of Tsinghua University, No. 6, Jiuxianqiao 1st Street, Chaoyang District, Beijing, 100016, China.

Heart Failure Reviews
|January 20, 2023
PubMed

Insights

Cardiac resynchronization therapy (CRT) combined with atrioventricular junction ablation (AVJA) effectively treats heart failure (HF) and atrial fibrillation (AF). This review explores CRT strategies with AVJA for improved HF patient outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Heart failure (HF) and persistent atrial fibrillation (AF) frequently coexist, worsening cardiac dysfunction and prognosis.
  • Cardiac resynchronization therapy (CRT) combined with atrioventricular junction ablation (AVJA) is a vital treatment for HF patients with AF unresponsive to or unsuitable for catheter ablation.

Purpose of the Study:

  • To review the clinical advancements of AVJA combined with various CRT strategies for treating HF patients with persistent AF.
  • To propose conversion CRT strategies (biventricular pacing/conduction system pacing-CRT) combined with AVJA as a potential therapeutic option.

Main Methods:

  • Review of current clinical CRT methods, including biventricular pacing (BVP)-based and conduction system pacing (CSP)-based approaches.
  • Analysis of the advantages, disadvantages, and clinical applications of different CRT strategies when combined with AVJA.

Main Results:

  • The CRT-AVJA combination therapy demonstrates significant improvements in clinical outcomes for HF patients.
  • Different CRT methods (BVP vs. CSP) have distinct clinical applications and considerations when used with AVJA.

Conclusions:

  • Conversion CRT strategies (BVP/CSP-CRT) combined with AVJA represent a promising alternative for managing HF patients with persistent AF.
  • Identified 7 categories of HF patients with persistent AF who may benefit from CRT-AVJA combination therapy.

Keywords:
Atrioventricular junction ablationCardiac resynchronization therapyHis bundle pacingLeft bundle branch pacingPersistent atrial fibrillation

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