Role of conduction system pacing in ablate and pace strategies for atrial fibrillation

Figures

• 

  Figure 1. Atrioventricular nodal ablation in a patient with His bundle pacing, showing complete atrioventricular block and selective His bundle pacing. Sweep speed set at 13 mm/s.

• 

  Figure 2. Ablation sites in a patient implanted with His bundle pacing (A) and with left bundle branch area pacing (B). Note that the distance to the lead tip is much greater in the latter instance. HBP = His bundle pacing; LAO = left anterior oblique; LBBAP = left bundle branch area pacing; RAO = right anterior oblique.

• 

  Figure 3. Atrioventricular node ablation in a patient with His bundle pacing, in whom there was a rise in threshold during radiofrequency application, with loss of capture by the His bundle lead and presence of backup right ventricular pacing (asterisk). The His lead was connected to the atrial port and the right ventricular lead to the ventricular port and the pacemaker was programmed in dual chamber pacing mode 30 b.p.m. with output of the His lead at 0.5 V/0.4 ms above threshold. Prompt cessation of radiofrequency delivery led to recovery of the His capture threshold.

• 

  Figure 4. Atrioventricular node ablation in a patient with His bundle pacing and complete left bundle branch block. (A) Correction of left bundle branch block with His bundle pacing. (B) Complete atrioventricular block was achieved by ablating the distal right bundle branch (at a safe distance from the tip of the His lead), resulting in paced rhythm with selective His capture and right bundle branch block.