Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are linked to adverse cardiac events.
• Right ventricular pacing is associated with a high incidence (up to 50%) of new-onset AHREs.
• His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) have shown potential for reducing AHREs compared to traditional pacing.

Purpose of the Study:

• To compare the incidence of new-onset AHRE between HBP and LBBAP.
• To evaluate the efficacy of HBP versus LBBAP in preventing atrial arrhythmias in patients with atrioventricular block.
• To identify predictors of AHRE in patients undergoing HBP or LBBAP.

Main Methods:

• A prospective study involving 142 patients with advanced atrioventricular block and no history of atrial fibrillation.
• Fifty-nine patients received HBP, and 83 patients received LBBAP.
• Patients were followed for the occurrence of new-onset AHRE detected by their devices.

Main Results:

• The incidence of new-onset AHRE was 13.5% in the HBP group and 16.8% in the LBBAP group (HR 0.91, p=0.84).
• The mean follow-up was approximately 644 days for both groups.
• Multivariate analysis indicated that only age and diabetes mellitus were significant predictors of AHRE, not the pacing type.

Conclusions:

• HBP and LBBAP demonstrate similar incidences of device-detected new-onset AHRE in patients with atrioventricular block.
• Both HBP and LBBAP appear to be safe alternatives regarding atrial arrhythmia burden in the medium term.
• Pacing strategy (HBP vs. LBBAP) did not significantly influence the occurrence of AHRE in this patient cohort.