His bundle pacing in patients with permanent atrial fibrillation and heart failure with non-reduced ejection fraction – retrospective study

Background: Heart failure (HF) constitutes a complex clinical entity and often coexists with atrial fibrillation (AF). There is a scarcity of evidence-based therapies for those with ejection fraction (EF) ≥ 40%. The effect restoring regular ventricular response in patients with HF with EF ≥ 40% and concomitant permanent AF is unknown. : This was a retrospective case-series study. 14 patients with symptomatic HF with EF ≥ 40% and permanent AF who had undergone permanent His bundle pacing (pHBP) were identified and enrolled. For 9 patients pHBP was a primary strategy, for the remaining patients it was an upgrade from right single chamber ventricular pacing. All patients underwent a follow-up visit 3 months after the procedure. Results: The severity of HF based on the New York Heart Association (NYHA) class was significantly reduced post-pHBP (mean 2.5 vs. 1.0, p-value < 0.001). Left ventricular ejection fraction significantly increased (mean increase 8.5%, p < 0.001) Similarly, significant decrease in the left ventricular end-diastolic diameter was observed after pHBP (mean decrease 5.4 mm, p < 0.001). The degree of mitral regurgitation after three months was lower (mean grade 2.4 vs. 1.2, p < 0.001). Conclusions: Permanent HBP might be beneficial in the setting of permanent AF and HF with EF ≥ 40%.