Online first
Original article
Published online: 2024-10-22
His bundle pacing is continually relevant for patients with atrial fibrillation and bradycardia without prior atrioventricular nodal ablation, data from mid-term follow-up
Abstract
Background: In patients with atrial fibrillation (AF) and symptomatic bradycardia, His Bundle pacing (HBP) is used to achieve an appropriate heart rate and physiological depolarization of the left ventricle (LV).
Aims: We aimed to evaluate the impact of HBP on LV function in two different populations: normal LV ejection fraction (LVEF) and low LVEF (<50%).
Methods: Patients who received HBP as de novo therapy or as an upgrade were divided into two groups based on initial LVEF, followed by echocardiographic and device monitoring.
Results: One hundred and twenty three patients (aged 76.0 [69.2-79.8] years, 74.0% men) with AF and bradycardia received HBP and completed follow-up with a median of 6.2 months (6.0–8.0). LV function remained unchanged in initially normal LV function patients (65 participants, LVEF 59.0% [55.0 - 62.0] vs. 58.0% [55.0-63.0]). In patients with low LVEF (58 participants), there was an increase in LVEF (37.5% [30.0-43.0] vs. 44.0% [35.0-50.0]; p < 0.0001), reduction of indexed LV end-systolic volume (62.4 [20.7] ml vs. 51.5 [21.5] ml; p = 0.001) and indexed LV end-diastolic volume (97.5 [26.2] ml vs. 88.1 [25.1] ml; p = 0.009), and improvement in the New York Heart Association class (2.3 [0.71] to 1.6 [0.9]; p < 0.0001).
Conclusion: With permanent HBP, patients with AF and bradycardia and without prior atrioventricular nodal ablation did not experience LV systolic function deterioration. Those with reduced baseline LVEF experienced improvements in LV function and its reverse remodeling at the mid-term follow-up.
Keywords: atrial fibrillationbradycardiaconduction system pacingheart failureLV reverse remodeling
References
- Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
- Sugumar H, Prabhu S, Voskoboinik A, et al. Arrhythmia induced cardiomyopathy. Journal of Arrhythmia. 2018; 34(4): 376–383.
- Somma V, Ha FJ, Palmer S, et al. Pacing-induced cardiomyopathy: a systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm. 2023; 20(2): 282–290.
- Loboda D, Gibinski M, Zietek K, et al. Survival of patients with pacing‐induced cardiomyopathy upgraded to CRT does not depend on defibrillation therapy. Pacing and Clinical Electrophysiology. 2020; 43(5): 471–478.
- Ploux S, Eschalier R, Whinnett ZI, et al. Electrical dyssynchrony induced by biventricular pacing: implications for patient selection and therapy improvement. Heart Rhythm. 2015; 12(4): 782–791.
- Auger D, Bleeker GB, Bertini M, et al. Effect of cardiac resynchronization therapy in patients without left intraventricular dyssynchrony. Eur Heart J. 2012; 33(7): 913–920.
- Li Y, Tian H, Zhang J, et al. Effects of His bundle pacing and right ventricular apex pacing on cardiac electrical and mechanical synchrony and cardiac function in patients with heart failure and atrial fibrillation. Am J Transl Res. 2021; 13(4): 3294–3301.
- Sharma PS, Dandamudi G, Naperkowski A, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015; 12(2): 305–312.
- Wijesuriya N, Mehta V, De Vere F, et al. The role of conduction system pacing in patients with atrial fibrillation. Front Cardiovasc Med. 2023; 10.
- Burri H, Jastrzebski M, Cano Ó, et al. EHRA clinical consensus statement on conduction system pacing implantation: executive summary. Endorsed by the Asia-Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS) and Latin-American Heart Rhythm Society (LAHRS). EP Europace. 2023; 25(4): 1237–1248.
- Dandamudi G, Vijayaraman P. How to perform permanent His bundle pacing in routine clinical practice. Heart Rhythm. 2016; 13(6): 1362–1366.
- Vijayaraman P, Dandamudi G, Zanon F, et al. Permanent His bundle pacing: recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm. 2018; 15(3): 460–468.
- Chung MK, Patton KK, Lau CP, et al. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023; 20(9): e17–e91.
- Raatikainen MJ, Arnar DO, Merkely B, et al. A decade of information on the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2017 report from the European Heart Rhythm Association. Europace. 2017; 19(suppl_2): ii1–ii90.
- Khurshid S, Choi SH, Weng LC, et al. Frequency of cardiac rhythm abnormalities in a half million adults. Circ Arrhythm Electrophysiol. 2018; 11(7): e006273.
- Timmis A, Vardas P, Townsend N, et al. European Society of Cardiology: cardiovascular disease statistics 2021. European Heart Journal. 2022; 43(8): 716–799.
- Clark DM, Plumb VJ, Epstein AE, et al. Hemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation. J Am Coll Cardiol. 1997; 30(4): 1039–1045.
- Natale A, Zimerman L, Tomassoni G, et al. Impact on ventricular function and quality of life of transcatheter ablation of the atrioventricular junction in chronic atrial fibrillation with a normal ventricular response. The American Journal of Cardiology. 1996; 78(12): 1431–1433.
- Gardas R, Golba KS, Soral T, et al. The effects of his bundle pacing compared to classic resynchronization therapy in patients with pacing-induced cardiomyopathy. J Clin Med. 2022; 11(19): 5723.
- Wu S, Su L, Vijayaraman P, et al. Left bundle branch pacing for cardiac resynchronization therapy: nonrandomized on-treatment comparison with his bundle pacing and biventricular pacing. Canadian Journal of Cardiology. 2021; 37(2): 319–328.
- Huang W, Wang S, Su L, et al. His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial. Heart Rhythm. 2022; 19(12): 1948–1955.
- Ma P, Yang Y, Dai B, et al. Brady‐arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his‐bundle pacing superior to biventricular pacing？. Pacing and Clinical Electrophysiology. 2021; 44(7): 1193–1199.
- Parlavecchio A, Vetta G, Caminiti R, et al. Left bundle branch pacing versus biventricular pacing for cardiac resynchronization therapy: A systematic review and meta-analysis. Pacing Clin Electrophysiol. 2023; 46(5): 432–439.
- Zanon F, Ellenbogen KA, Dandamudi G, et al. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace. 2018; 20(11): 1819–1826.
- Huang W, Su L, Wu S, et al. Benefits of permanent his bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction. J Am Heart Assoc. 2017; 6(4): e005309.
- Occhetta E, Bortnik M, Magnani A, et al. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol. 2006; 47(10): 1938–1945.
- Jastrzębski M, Moskal P, Bednarek A, et al. His-bundle pacing as a standard approach in patients with permanent atrial fibrillation and bradycardia. Pacing Clin Electrophysiol. 2018; 41(11): 1508–1512.
- Fularz M, Mitkowski P. The impact of operator experience on the success rate, time aspects, and electrocardiographic features in left bundle branch area pacing. Kardiol Pol. 2023; 81(11): 1140–1142.
- Sheng X, Pan Y, Yu C, et al. Comparison of synchronization between left bundle branch and his bundle pacing in atrial fibrillation patients: An intra‐patient‐controlled study. Pacing Clin Electrophysiol. 2021; 44(9): 1523–1531.
- Bednarek A, Kiełbasa G, Moskal P, et al. Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation. Pacing Clin Electrophysiol. 2023; 46(7): 629–638.
- Ravi V, Beer D, Pietrasik GM, et al. Development of new-onset or progressive atrial fibrillation in patients with permanent HIS bundle pacing versus right ventricular pacing: results from the RUSH HBP registry. J Am Heart Assoc. 2020; 9(22): e018478.
- Zhu H, Li X, Wang Z, et al. New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study. Europace. 2023; 25(1): 121–129.
- Zhang S, Yang W, Wang S, et al. New-onset atrial high-rate episodes in left bundle branch area pacing versus right ventricular pacing for patients with atrioventricular block. Kardiol Pol. 2024; 82(6): 632–639.
- Pestrea C, Cicala E, Gherghina A, et al. Feasibility of permanent his bundle pacing in the elderly vs the very elderly. A single-center mid-term follow-up study. Clin Interv Aging. 2023; 18: 941–949.
- Jiang Z, Chen Y, Chen C, et al. Feasibility and safety of left bundle branch area pacing in very elderly patients (≥80 years). Kardiol Pol. 2022; 80(4): 452–460.
- Shan P, Su L, Zhou X, et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50. Heart Rhythm. 2018; 15(3): 405–412.
