His-optimized cardiac resynchronization therapy with left-sided AV node ablation improved LVEF from 41% to 51% and reduced right ventricular dimensions from 41 mm to 35 mm over 6 months.
Case Report (n=1)
Does His-optimized CRT with AVNA improve cardiac function and symptoms in a patient with HF, AF, and RBBB?
His-optimized CRT with AVNA may be a beneficial strategy for improving cardiac function and symptoms in patients with heart failure, atrial fibrillation, and right bundle branch block.
BACKGROUND: Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. CASE SUMMARY: We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. DISCUSSION: Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.
Volkov et al. (Sun,) conducted a case report in Heart failure, permanent atrial fibrillation, and right bundle branch block (n=1). His-optimized cardiac resynchronization therapy with left-sided atrioventricular node ablation was evaluated on Left ventricular ejection fraction, right ventricle dimensions, and clinical status. His-optimized cardiac resynchronization therapy with left-sided AV node ablation improved LVEF from 41% to 51% and reduced right ventricular dimensions from 41 mm to 35 mm over 6 months.
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