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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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His bundle pacing combined with atrioventricular node ablation for atrial fibrillation: a systematic review and

Liang Xu1,2,3, Dongdong Que1,2,3, Wenjie Yu1,2,3

  • 1Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Expert Review of Medical Devices
|September 13, 2024
PubMed

Insights

His bundle pacing with atrioventricular node ablation is effective for atrial fibrillation, showing improvements in heart function. However, it has a lower success rate and more complications compared to other pacing methods.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • His bundle pacing (HBP) is a potential alternative to biventricular pacing (BVP) for heart failure management.
  • High capture thresholds and backup lead requirements can limit HBP's widespread adoption.
  • Atrial fibrillation (AF) management often involves pacing strategies.

Purpose of the Study:

  • To assess the efficacy and safety of His bundle pacing combined with atrioventricular node ablation (AVNA) for patients with AF.
  • To compare the outcomes of HBP+AVNA with BVP and left bundle branch pacing (LBBP).

Main Methods:

  • A systematic review and meta-analysis of studies comparing HBP, BVP, and LBBP.
  • Databases searched include PubMed, Embase, Web of Science, and Cochrane Library.
  • Key outcome measures: left ventricular ejection fraction (LVEF), NYHA score, QRS duration (QRSd), and pacing threshold.

Main Results:

  • Thirteen studies involving 1115 patients were analyzed.
  • HBP improved LVEF, reduced NYHA score, and increased QRSd, with a higher pacing threshold compared to baseline.
  • HBP demonstrated comparable efficacy to BVP and LBBP but had a lower success rate (85.97%) and higher complication rate (16.1%).

Conclusions:

  • His bundle pacing combined with AVNA is an effective strategy for managing AF.
  • Despite its effectiveness, HBP has limitations including a lower success rate and increased complications.
  • Further research is needed to establish the superiority of HBP over BVP and LBBP.
Abstract

Keywords:
Atrial fibrillationatrioventricular node ablationbiventricular pacinghis bundle pacingleft bundle branch pacingmeta-analysis

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