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Related Experiment Video

Updated: Jul 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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Conduction system pacing and atrioventricular node ablation in heart failure: The PACE-FIB study design.

Daniel Rodríguez Muñoz1,2, María Generosa Crespo-Leiro3,4,5, Ignacio Fernández Lozano6,7

  • 1Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.

ESC Heart Failure
|September 21, 2023
PubMed
Summary

Left-bundle branch pacing (LBBP) combined with atrioventricular node ablation (AVNA) shows promise for heart failure patients with atrial fibrillation (AF). This study compares LBBP-AVNA to drug therapy for improved outcomes in heart failure with preserved or mildly reduced ejection fraction.

Keywords:
Atrial fibrillationAtrioventricular nodeHeart failureLeft bundle branch pacingPacemaker

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Robotic Ablation of Atrial Fibrillation
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Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Atrial fibrillation (AF) negatively impacts prognosis in heart failure (HF) patients.
  • Effective treatments are limited for permanent AF in heart failure with preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF).

Purpose of the Study:

  • To evaluate the long-term benefits and safety of heart rate regularization using left-bundle branch pacing (LBBP) and atrioventricular node ablation (AVNA).
  • To compare the LBBP-AVNA strategy against standard pharmacological rate control in HFpEF/HFmrEF patients with permanent AF.

Main Methods:

  • The PACE-FIB trial is a prospective, multicentre, open-label, randomized study (1:1 ratio).
  • 334 patients with HFpEF/HFmrEF and permanent AF will be randomized to either LBBP followed by AVNA or optimal pharmacological rate control.
  • Follow-up duration is a minimum of 36 months, with a composite primary outcome of all-cause mortality, HF hospitalization, and worsening HF.

Main Results:

  • The study is ongoing, with recruitment between March 2022 and February 2027.
  • Primary outcome data at 36 months will assess the composite endpoint.
  • Secondary outcomes include echocardiographic parameters, functional status, and adverse events.

Conclusions:

  • Left-bundle branch pacing (LBBP) presents a promising approach for heart rate regularization.
  • The pace-and-ablate strategy (LBBP + AVNA) may offer clinical benefits over pharmacological rate control in this patient population.
  • This is the first randomized trial to investigate the long-term efficacy and safety of LBBP-AVNA in HFpEF/HFmrEF with permanent AF.