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

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  • Additional Information
    • Source:
      Publisher: Elsevier Masson Country of Publication: Netherlands NLM ID: 101465655 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1875-2128 (Electronic) Linking ISSN: 18752128 NLM ISO Abbreviation: Arch Cardiovasc Dis Subsets: MEDLINE
    • Publication Information:
      Original Publication: Amsterdam ; Boston : Elsevier Masson
    • Subject Terms:
      Bundle of His*/physiopathology ; Cardiac Pacing, Artificial* ; Atrioventricular Node*/physiopathology ; Atrioventricular Node*/surgery; Humans ; Prospective Studies ; Male ; Female ; Aged ; Treatment Outcome ; Time Factors ; Middle Aged ; Catheter Ablation/adverse effects ; Heart Rate ; Risk Factors ; Atrioventricular Block/therapy ; Atrioventricular Block/physiopathology ; Atrioventricular Block/diagnosis ; Aged, 80 and over ; Heart Failure/physiopathology ; Heart Failure/therapy ; Heart Failure/diagnosis ; Heart Failure/mortality ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/therapy ; Atrial Fibrillation/surgery ; Action Potentials
    • Abstract:
      Background: Pacemaker implantation combined with atrioventricular node ablation (AVNA) is a well-established strategy for uncontrolled atrial arrhythmias. Limited data are available regarding His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in this setting.
      Aim: To compare the outcomes of HBP and LBBAP in patients undergoing pacemaker implantation combined with AVN in routine clinical practice.
      Methods: We prospectively included all patients who underwent AVNA after successful conduction system pacing (CSP) in two hospitals between September 2017 and May 2023. The primary outcome was the 1-year composite of first episode of heart failure hospitalization, symptomatic atrioventricular node reconduction requiring a second AVNA procedure, lead revision or death from any cause.
      Results: A total of 164 patients underwent AVNA following successful CSP (68 HBP and 96 LBBAP). Mean pacemaker implantation and AVNA procedure times were shorter in the LBBAP group than the HBP group (46±18 vs 59±23min; P<0.001 and 31±12 vs 43±22min, respectively; P<0.001). Complete atrioventricular block was more frequently obtained in the LBBAP group (88/96 patients [92%] vs 54/68 patients [79%]; P=0.04). One-year freedom from the composite outcome was more frequent in the LBBAP group (89.7% vs 72.9%; hazard ratio 0.32, 95% confidence interval 0.14-0.72; P=0.01). The strategy was similarly effective in both groups with a significant improvement in NYHA class and left ventricular ejection fraction. A secondary pacing threshold elevation >1V occurred only in the HBP group (11%).
      Conclusion: In this prospective, comparative study, LBBAP provided better 1-year outcomes than HBP.
      (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)
    • Contributed Indexing:
      Keywords: Atrial fibrillation; Atrioventricular node ablation; Conduction system pacing; His-bundle pacing; Left bundle branch area pacing
    • Publication Date:
      Date Created: 20240709 Date Completed: 20240926 Latest Revision: 20241205
    • Publication Date:
      20241209
    • Accession Number:
      10.1016/j.acvd.2024.05.118
    • Accession Number:
      38981841