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Review
. 2023 Jun 26;10(7):272.
doi: 10.3390/jcdd10070272.

Outcomes of Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing

Ioanna Koniari  1 , Andreas Gerakaris  2 , Nicholas Kounis  3 , Dimitrios Velissaris  2 , Archana Rao  1 , Mark Ainslie  4 , Ahmed Adlan  4 , Panagiotis Plotas  5 , Ignatios Ikonomidis  6 , Virginia Mplani  7 , Ming-Yow Hung  8   9   10 , Cesare de Gregorio  11 , Theofilos Kolettis  12 , Dhiraj Gupta  1
Affiliations
Review

Outcomes of Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Atrial Fibrillation: From Cardiac Resynchronization Therapy to His Bundle Pacing

Ioanna Koniari et al. J Cardiovasc Dev Dis. .

Abstract

Objective: To review the relevant literature on the use of atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation. Methods: APubMed/MEDLINE and SCOPUS search was performed in order to assess the clinical outcomes of atrioventricular node ablation and pacemaker implantation, as well as the complications that may occur. Results: Several clinical trials, observational analyses and meta-analyses have shown that the "pace and ablate" strategy not only improves symptoms but also can enhance cardiac performance in patients with heart failure and atrial fibrillation. Although this procedure is effective and safe, some complications may occur including worsening of heart failure, permanent fibrillation, arrhythmias and sudden death. Regarding pacemaker implantation, cardiac resynchronization therapy is shown to be the optimal choice compared to right ventricle apical pacing. His bundle pacing is a promising alternative to cardiac resynchronization therapy and has shown beneficial effects, while left bundle branch pacing is an innovative modality. Conclusions: Atrioventricular node ablation and pacemaker implantation is shown to have beneficial effects on clinical outcomes of patients with atrial fibrillation ± heart failure who do not respond or are intolerant to medical treatment. Cardiac resynchronization therapy is the treatment of choice and His bundle pacing seems to be an effective alternative way of pacing in these patients.

Keywords: His bundle pacing; atrial fibrillation; atrioventricular node ablation; cardiac resynchronization therapy; heart failure.

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
Patients with AF undergoing AV node ablation indications and advantages of different pacing modalities. In patients with symptomatic AF and uncontrolled heart rate, who are eligible for AVJ ablation, CRT is recommended in patients with HFrEF (Class I, Level of Evidence B) and it should be preferred over RV pacing in patients with HFmrEF (Class IIa, Level of Evidence C). In patients with HFpEF there is a Class IIa, Level of Evidence B recommendation for RV pacing. HBP as a more physiological treatment option is indicated in patients who are eligible for CRT, but the coronary sinus lead implantation is unsuccessful (Class IIa, Level of Evidence B). P1:VVIR pacing, P2: CRT pacing, P3:His bundle pacing (HBP), AVNA = AV node ablation, * CRTbeneficial outcomes, † AV node plus VVIR pacing benefits based on trials, ↓ decrease,↑ increase.
See this image and copyright information in PMC

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