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Recently, left bundle branch pacing (LBBP) has been proven effective in patients with atrial fibrillation (AF) underwent atrioventricular node (AVN) ablation, which could provide more space for AVN ablation and lower threshold compared to His bundle pacing (HBP). However, the data on the success rate and pacing parameters of LBBP in patients underwent AVN ablation for AF remains limited.
This study aimed to compare the pacing parameters and success rate between LBBP and HBP in patients with AF underwent AVN ablation.
From June 2017 to December 2019, consecutive patients with AF and HF who underwent AVN ablation and LBBP/HBP were enrolled. Pacing parameters were assessed at implant and during follow-up.
A total of 291 patients were enrolled with 215 primary HBP and 76 primary LBBP. 23 had unacceptable HBP and transferred to LBBP. The success rate of permanent LBBP was higher than that of HBP (100% vs 81.5%, Figure 1). During LBBP, the acute threshold was 0.47±[email protected] and the acute R-waves was 10.9±4.9 mv (N=99). During HBP, the acute threshold was 0.92±[email protected] and the acute R-waves was 3.4±3.2 mv (N=176). In subgroup analysis, LBBP group with different QRS morphology all have lower thresholds and higher sensed R-waves compared to HBP group. None of the patients that underwent LBBP has increased threshold after ablation (>[email protected]). During follow-up, 10 (5.7%) patients occurred increased threshold (>[email protected]) in HBP group while 1 (1%) patient in LBBP group.
LBBP combined AVN ablation have well pacing parameter in patients with AF and HF and is emerging as a necessary bailout technique for unacceptable HBP following AVN ablation.