His-Purkinje System Pacing Upgrade Improve the Heart Performances in Patients Suffering from Pacing-induced Cardiomyopathy with or without Permanent Atrial Fibrillation

The efficacy and safety of His bundle pacing (HBP) and left bundle branch pacing (LBBP) upgrades in patients with pacing-induced cardiomyopathy (PICM) and atrial fibrillation (AF) are still unknown. Methods and results Patients with PICM were continuous enrolled from January 2018 to March 2020. All patients were further divided into AF subgroup and sinus rhythm subgroup. Clinical data including echocardiographic examination parameters, electrocardiogram (ECG) measurements, and New York Heart Association (NYHA) classification, were assessed before and after a his-purkinje system pacing (HPSP) upgrade. The HBP and LBBP upgrades were completed in 34 of 36 (94%), Complications including electrode dislodged, perforation, infection or thrombosis were not observed in perioperative period. During a mean of 11.52±5.40 months of follow-up. The left ventricular ejection fraction (LVEF) increased significantly (33.76±7.54 vs 40.41±9.06, P<0.001), and the QRS duration decreased (184.22±23.76ms vs 120.52±16.67ms, P<0.001) after the HBP upgrades. LVEDD reversed from 59.29±7.74 mm to 53.91±5.92 mm (P<0.001), and the NYHA functional class also improved to 2.00±0.76 from 2.55±0.91 at the first follow-up (P<0.001). The left atrium (LA) size also slightly decreased compared to the initial state (59.29±7.74mm VS 56.44±6.46, P=0.005). The threshold o did not increase significantly (1.18±0.76 mv@0.4ms vs 1.26±0.91mv @ 0.4ms, P=0.581). These improvements in patients with AF were similar with those in patients without AF (P >0.05). Conclusion HBP and LBBP upgrades improved the heart performance and reversed the left ventricular remodeling in patients suffering from PICM with or without AF, and it should be a promising choice in these patients.