His bundle pacing versus left bundle branch area pacing in patients undergoing atrioventricular node ablation: A...

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Cardiac Pacing

Background:

• Atrioventricular node ablation (AVNA) with pacemaker implantation is standard for uncontrolled atrial arrhythmias.
• Limited comparative data exist for His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in this context.

Purpose of the Study:

• To compare the clinical outcomes of HBP versus LBBAP in patients undergoing AVNA.
• To evaluate the safety and efficacy of conduction system pacing strategies combined with AVNA.

Main Methods:

• Prospective study of 164 patients undergoing AVNA after successful conduction system pacing (CSP) between 2017 and 2023.
• Primary outcome: 1-year composite of heart failure hospitalization, reconduction, lead revision, or death.
• Comparison of procedural times, atrioventricular block achievement, and long-term clinical outcomes.

Main Results:

• Left bundle branch area pacing (LBBAP) group had shorter implantation and AVNA procedure times.
• Higher rate of complete atrioventricular block achieved with LBBAP (92% vs. 79%).
• One-year freedom from composite adverse events was significantly higher in the LBBAP group (89.7% vs. 72.9%).

Conclusions:

• Left bundle branch area pacing (LBBAP) demonstrates superior 1-year outcomes compared to His bundle pacing (HBP) when combined with AVNA.
• Both pacing strategies effectively improved heart failure symptoms and left ventricular function.
• A higher incidence of pacing threshold elevation was noted with HBP.