Feasibility and Efficacy of His Bundle Pacing or Left Bundle Pacing Combined With Atrioventricular Node Ablation in Patients With Persistent Atrial Fibrillation and Implantable Cardioverter‐Defibrillator Therapy

Figure 1. Schematic summary of study and patient flow. AF indicates atrial fibrillation; AVN, atrioventricular node; HF, heart failure; HPSP, His‐Purkinje conduction system pacing; ICD, implantable cardioverter‐defibrillator; IS, inappropriate shock.

Figure 2. Kaplan–Meier curves showing probability of inappropriate shocks and event‐free survival. A, The cumulative proportion of patients who experienced a first inappropriate therapy is plotted against time. B, Kaplan–Meier survival curves for adverse outcomes (death or heart failure hospitalization). The number of patients at risk at a given time point of follow‐up is indicated below the x‐axis.

Figure 3. Paired LVEF/LVESV at baseline and during follow‐up. A and B, LVEF (A) and LVESV (B) of all patients in groups 1 and 2 at baseline and during follow‐up. LVEF (C) and LVESV (D) of patients with baseline ejection fraction ≤40% in groups 1 and 2 at baseline and during follow‐up. LVEF indicates left ventricular ejection fraction; LVESV, left ventricular end‐systolic volume.

Figure 4. Electrical parameters of His‐Purkinje conduction system pacing at implant (BL) and during the follow‐up period (1 mo, 6 mo, and 1 y). A, Pacing threshold. B, Sensed R‐wave amplitude. BL indicates baseline; HBP, His bundle pacing; LBBP, left bundle‐branch pacing.

Figure 5. Case example of atrioventricular node (AVN) ablation combined with His bundle pacing (HBP) in a patient with persistent atrial fibrillation with heart failure and cardiac resynchronization therapy defibrillator implantation. A, Native ECG. B, Electrogram after ablation. C, His bundle pacing. Radiograph before (D) and 2 years after (E) AVN ablation and HBP.

Figure 6. Case example of atrioventricular node (AVN) ablation combined with left bundle‐branch pacing (LBBP) in a persistent atrial fibrillation (AF) patient with heart failure and previous inappropriate implantable cardioverter‐defibrillator shocks. A, Native ECG. B, Inappropriate shock caused by AF. C, LBBP. Radiograph before (D) and 6 months after (E) AVN ablation and LBBP.