Feasibility of Left Bundle Branch Area Pacing Combined with Atrioventricular Node Ablation in Atrial Fibrillation Patients with Heart Failure

Figures

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  Figure 1. Left bundle branch area pacing. (A): Diagram of the LBBaP and AVNA. (B): LBB potential recorded from the 3830 lead (dash arrow). Baseline QRSd of 88 ms. (C): The 3830 lead implanted in LBB area successfully; unipolar LBBaP pacing at pacing at 1 V/0.4 ms resulted in LBB capture with QRSd of 107 ms and Stim-LVAT of 77 ms. (D,E): Fluoroscopic imaging of LBBaP lead implantation ((D): RAO 30-deegree fluoroscopic views and (E): LAO 45-degree fluoroscopic view). (F,G): Echo images demonstrating the location of the LBBaP lead in the interventricular septum ((F): apical 4-chamber view and (G): left parasternal short axis transection view). (H): Radiograph of chest after LBBaP and AVN ablation (posteroanterior view). LBB = left bundle branch, LBBaP = left bundle branch area pacing, AVNA = atrioventricular node ablation, RAO = right anterior oblique, LAO = left anterior oblique, RV = right ventricle, LV = left ventricle, Stim-LVAT = pacing stimulus to left ventricular activation time, Echo = echocardiography.

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  Figure 2. (A) Baseline LVEF and ΔQRSd predicted the magnitude of improvement of LVEF at 1 year after LBBaP and AVNA. The multiple linear regression equation is “ΔLVEF = 44.295-0.463 * baseline LVEF-0.182 * ΔQRSd”, indicating that the lower the baseline LVEF, the smaller the QRSd broadening, or the more obvious the QRSd shortening at implantation, the more significant the improvement of LVEF at 1-year follow-up. (B) Comparison of baseline Echo parameters between LBBaP and LVSP groups. There were statistical differences in RALRD, IVST, and the degree of TR between the two groups. (C,D) Scatter plots and ROC curve. The cut of values of RALRD, IVST, and the degree of TR were 49mm, 13mm, and 1(mild regurgitation), respectively. Additionally, the AUC values were 0.791, 0.867 and 0.717, respectively. When the RALRD > 49 mm, IVST > 13 mm, and the degree of TR were moderate or severe, LBBaP was more likely to fail. LVEF = left ventricular ejection fraction, IVST = interventricular septum thickness, TR = tricuspid regurgitation, RALRD = right atrial left-right diameter, LBBaP = left bundle branch area pacing, LVSP = left ventricular septal pacing, AVNA = atrioventricular node ablation, Echo =…