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. 2022 Jul;19(7):1116-1123.
doi: 10.1016/j.hrthm.2022.03.1222. Epub 2022 Mar 26.

Atrioventricular junction ablation in patients with conduction system pacing leads: A comparison of His-bundle vs left bundle branch area pacing leads

Ajay Pillai  1 , Jeffrey Kolominsky  1 , Jayanthi N Koneru  1 , Jordana Kron  1 , Richard K Shepard  1 , Gautham Kalahasty  1 , Weijian Huang  2 , Atul Verma  3 , Kenneth A Ellenbogen  4
Affiliations

Atrioventricular junction ablation in patients with conduction system pacing leads: A comparison of His-bundle vs left bundle branch area pacing leads

Ajay Pillai et al. Heart Rhythm. 2022 Jul.

Abstract

Background: Single-center studies have shown feasibility of conduction system pacing (CSP) via His-bundle pacing (HBP) or left bundle branch area pacing (LBBAP) in atrial fibrillation (AF) patients undergoing atrioventricular junction ablation (AVJA).

Objective: The purpose of this study was to compare outcomes in patients with HBP and LBBAP leads undergoing AVJA.

Methods: Consecutive patients with CSP leads referred for AVJA between October 2014 and May 2021 were included. Pacing lead characteristics, procedural characteristics, complications, and long-term outcomes were assessed.

Results: One hundred five AVJA procedures (55 HBP, 50 LBBAP) were performed in 98 patients (48 HBP, 50 LBBAP). The acute success rate of the AVJA procedure was 94% vs 100% (P = .11) in HBP vs LBBAP groups. Seven (14%) redo AVJA procedures were required in the HBP group. Mean procedural time (44 ± 24 min vs 34 ± 16 min; P = .02) and mean fluoroscopy time (16 ± 18 min vs 7 ± 6 min; P <.001) were significantly longer in the HBP vs LBBAP group. An acute rise in threshold was noted in 8 cases (14.5%), and 4 (8%) developed exit block after AVJA in HBP patients. Chronic HBP threshold ≥2.5 V was seen in 23 patients (48%), and 4 (8%) HBP leads were deactivated. CSP preserved ejection fraction (EF) in the overall cohort (N = 70; 53% ± 10% vs 55% ± 10%; P = .09) and significantly improved in those with reduced EF <50% at baseline (N = 16; 37% ± 7.6% vs 46% ± 13%; P = .02).

Conclusion: AVJA in the presence of an LBBAP lead is associated with a higher success rate and fewer acute and chronic lead-related complications. CSP with either HBP or LBBAP preserves left ventricular systolic function in patients with refractory atrial fibrillation post AVJA.

Keywords: Atrial fibrillation; Atrioventricular junction ablation; Conduction system pacing; His-bundle pacing; Left bundle branch area pacing.

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