Brady-arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his-bundle pacing superior to biventricular pacing？.

Abstract

OBJECTIVE:

To investigate the efficacy and safety of His-bundle pacing (HBP) compared with the traditional biventricular pacing (BVP) on patients with brady-arrhythmias, who suffer from permanent atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF).

METHODS:

All patients with brady-arrhythmias, permanent AF and HFrEF were continuously enrolled from January 2017 to July 2019 and followed up for at least 12 months. The differences in QRS duration (QRSd), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), tricuspid regurgitation grade, mitral regurgitation grade, left ventricular end-diastolic diameter (LVEDD), and left atrial size were compared.

RESULTS:

A total of 52 patients were enrolled: 37 patients were with HBP and 15 patients with BVP. There was no electrode dislodged, perforation, infection or thrombosis during the follow-up of 18.12 ± 4.45 months. The success rate for HBP implantation was 88.10%. The capture threshold of his-bundle and the threshold of the left ventricular lead remained stable during follow-up. LVEF increased to higher than 50% in 11 patients with HBP (29.73%). The NYHA classification (both p < .001), LVEF (both p < .001) and LVEDD improved significantly during the follow-up in both groups. NYHA (p = .030), LVEF (p = .013), and LVEDD (p = .003) improved in patients with HBP compared with BVP.

CONCLUSION:

HBP was safe and more effective in improving the cardiac function and remodeling in patients with brady-arrhythmias, permanent AF and HFrEF compared with BVP.

• Authors: Pei-Pei Ma, Yi-Heng Yang, Bai-Ling Dai, Rong-Feng Zhang, Nan Wang, Dan-Na Li, Xiao-Meng Yin, Lian-Jun Gao, Yun-Long Xia, Yan-Zong Yang, Ying-Xue Dong
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 44 Issue 7 Pg. 1193-1199 (Jul 2021) ISSN: 1540-8159 [Electronic] United States
• PMID: 34080696 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2021 Wiley Periodicals LLC.

Topics

• Aged
• Aged, 80 and over
• Atrial Fibrillation (complications, physiopathology)
• Bradycardia (etiology, therapy)
• Bundle of His (physiopathology)
• Cardiac Resynchronization Therapy (adverse effects, methods)
• Female
• Heart Failure (complications, physiopathology)
• Humans
• Male
• Middle Aged
• Stroke Volume
• Treatment Outcome