Key result
His-Purkinje pacing plus AVNA linked to ~21-point higher AFEQT scores in refractory persistent AF.
Why the study?
Recurrence of AF is common even after multiple ablations, and whether HPCSP combined with AVNA improves quality of life, alleviates symptoms, and is safe and feasible in older patients with refractory symptomatic persistent AF was unknown.
Does His-Purkinje conduction system pacing combined with atrioventricular node ablation improve quality of life and alleviate symptoms in older patients with symptomatic persistent atrial fibrillation refractory to multiple ablation procedures?
Observational (n=31)
Does His-Purkinje conduction system pacing combined with atrioventricular node ablation improve quality of life and alleviate symptoms in older patients with symptomatic persistent atrial fibrillation refractory to multiple ablation procedures?
Absolute Event Rate: 70.9% vs 49.6%
p-value: p=0.001
His-Purkinje conduction system pacing combined with AV node ablation is safe and significantly improves quality of life and symptoms in older patients with persistent AF refractory to multiple ablations.
May improve QoL in refractory AF; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND Recurrence of atrial fibrillation (AF) is common in patients with persistent AF even after multiple ablation procedures. His-Purkinje conduction system pacing (HPCSP) combined with atrioventricular node ablation (AVNA) is effective in managing patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy. METHODS Older patients (≥ 65 years) with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rhythm Association (EHRA) scores, and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination. RESULTS Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were 100% for HPCSP (22 cases with His bundle pacing, and 9 cases with left bundle branch pacing) and 93.3% (28/30) for AVNA, respectively. By the 6-month follow-up examination, EHRA scores improved significantly (3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014) and AFEQT scores increased markedly (49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001). No severe complications developed. CONCLUSIONS When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This therapy was proved to be safe and effective in this patient population.
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Peng et al. (2023) conducted an observational in symptomatic persistent atrial fibrillation refractory to multiple ablation procedures (n=31). His-Purkinje conduction system pacing combined with atrioventricular node ablation vs. Baseline was evaluated on Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores at 6 months (p=0.001). His-Purkinje conduction system pacing combined with AVNA significantly improved AFEQT scores (70.9 vs 49.6, P=0.001) and EHRA scores at 6 months in older patients with refractory persistent AF.
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