Key result
Permanent His-bundle pacing after atrioventricular node ablation reduced pulmonary capillary wedge pressure V-wave amplitude to 13 mmHg and increased cardiac output to 3.66 L/min compared to right ventricular apical pacing.
Why the study?
Does permanent His-bundle pacing improve hemodynamics and mitral regurgitation compared to right ventricular pacing in a patient undergoing AVN ablation for chronic atrial fibrillation?
Case Report (n=1)
No
Does permanent His-bundle pacing improve hemodynamics and mitral regurgitation compared to right ventricular pacing in a patient undergoing AVN ablation for chronic atrial fibrillation?
Absolute Event Rate: 13% vs 17%
Permanent His-bundle pacing after AVN ablation may provide superior hemodynamic benefits, preserve synchronous ventricular contraction, and reduce mitral regurgitation compared to conventional right ventricular pacing.
May support hemodynamic benefits of His-bundle pacing post-AVN ablation; hypothesis-generating and should not yet change practice.
Hemodynamic deterioration because of worsening of mitral regurgitation can occur in a small number of patients undergoing atrioventricular node (AVN) ablation and pacing therapy. Patients with moderate mitral regurgitation before ablation seem prone to this complication. Successful permanent His-bundle pacing after AVN ablation was performed in a patient with chronic atrial fibrillation and moderate mitral regurgitation. Pulmonary capillary wedge pressure V-wave amplitude was markedly diminished and the mitral regurgitation area, calculated from the echocardiogram, was decreased by His-bundle pacing compared with that during right ventricular outflow tract or apical pacing.
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Yamauchi et al. (2005) conducted a case report in Chronic atrial fibrillation and mitral regurgitation (n=1). Permanent His-bundle pacing after atrioventricular node ablation vs. Right ventricular apical (RVA) pacing was evaluated on Peak V-wave amplitude in pulmonary capillary wedge pressure (PCWP). Permanent His-bundle pacing after atrioventricular node ablation reduced pulmonary capillary wedge pressure V-wave amplitude to 13 mmHg and increased cardiac output to 3.66 L/min compared to right ventricular apical pacing.
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