Key result
Conduction system pacing linked to ~39% lower death or HF hospitalization vs conventional pacing post-AV ablation.
Why the study?
Conduction system pacing preserves ventricular synchrony, but its clinical outcomes compared to conventional pacing in patients undergoing atrioventricular node ablation needed evaluation.
Does conduction system pacing reduce the combined endpoint of time to death or heart failure hospitalization compared to conventional pacing in patients with refractory atrial fibrillation undergoing atrioventricular node ablation?
Observational (n=223)
Yes
Does conduction system pacing reduce the combined endpoint of time to death or heart failure hospitalization compared to conventional pacing in patients with refractory atrial fibrillation undergoing atrioventricular node ablation?
Effect estimate: HR 0.61 (95% CI 0.42-0.89)
Absolute Event Rate: 48% vs 62%
p-value: p=<0.01
Conduction system pacing is a safe and effective alternative to conventional pacing for patients undergoing atrioventricular node ablation, though it did not significantly reduce individual outcomes of death or heart failure hospitalization.
May support conduction system pacing after AV node ablation; hypothesis-generating and requires randomized confirmation before practice change.
Background: Atrioventricular node ablation (AVNA) with right ventricular or biventricular pacing (conventional pacing; CP) is an effective therapy for patients with refractory atrial fibrillation (AF). Conduction system pacing (CSP) using His bundle pacing or left bundle branch area pacing preserves ventricular synchrony. Objective: The aim of our study is to compare the clinical outcomes between CP and CSP in patients undergoing AVNA. Methods: Patients undergoing AVNA at Geisinger Health System between January 2015 and October 2020 were included in this retrospective observational study. CP or CSP was performed at the operators' discretion. Procedural, pacing parameters, and echocardiographic data were assessed. Primary outcome was the combined endpoint of time to death or heart failure hospitalization (HFH) and was analyzed using Cox proportional hazards. Secondary outcomes were individual outcomes of time to death and HFH. Results: < .01). There was no reduction in the individual secondary outcomes of time to death and HFH in the CSP group compared to CP. Conclusion: CSP is a safe and effective option for pacing in patients with AF undergoing AVNA in high-volume centers.
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Vijayaraman et al. (2022) conducted an observational in Atrial fibrillation refractory to pharmacological therapy (n=223). Conduction system pacing (CSP) vs. Conventional pacing (CP) was evaluated on Time to death or heart failure hospitalization (HR 0.61, 95% CI 0.42-0.89, p=<0.01). Conduction system pacing significantly reduced the combined endpoint of time to death or heart failure hospitalization (HR 0.61) compared to conventional pacing in patients undergoing AV node ablation.
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