Key result
Renal dysfunction linked to ~7.9-fold higher HF hospitalization risk after LBBAP and AVN ablation.
Why the study?
Left bundle branch area pacing with AVN ablation is a promising therapy for patients with AF and symptomatic HF, but predictors of which patients are likely responders versus those who derive limited benefit remained unclear.
Does left bundle branch area pacing combined with atrioventricular node ablation prevent heart failure hospitalization in patients with atrial fibrillation and symptomatic heart failure, and what baseline factors predict this outcome?
Cohort (n=98)
Does left bundle branch area pacing combined with atrioventricular node ablation prevent heart failure hospitalization in patients with atrial fibrillation and symptomatic heart failure, and what baseline factors predict this outcome?
In patients with atrial fibrillation and heart failure undergoing left bundle branch area pacing and AV node ablation, reduced renal function (eGFR ≤ 60 mL/min/1.73m2), left atrial enlargement (LAD ≥ 50 mm), and male sex strongly predict subsequent heart failure hospitalization, aiding in patient selection for this therapy.
Answers are grounded in this paper and cite their sources.
eGFR ≤60, LAD ≥50 mm, and male sex predict HFH after LBBAP-AVN ablation; leaves open whether they should guide selection pending validation.
Background Left bundle branch area pacing (LBBAP) with atrioventricular node (AVN) ablation has emerged as a promising therapy for patients with atrial fibrillation (AF) and symptomatic heart failure (HF). However, it remains unclear which patients are likely responders and which may derive limited benefit. Objective This study aimed to identify predictors of unfavorable therapeutic outcomes following this ‘ablate and pace’ therapy. Methods Consecutive patients with successful LBBAP and AVN ablation were included. Baseline characteristics and long-term outcomes were assessed. Multivariable cox regression and reclassification analysis were used to evaluate the predictors of heart failure hospitalization (HFH). Results Ninety-eight patients (age 73.1 ± 8.9 years; ventricular rate 93.6 ± 18.7 bpm; 41.8% male) were enrolled. During 43.9 ± 19.4 months of follow-up, 19 (19.4%) patients experienced HFH. The eGFR ≤ 60 mL/min/1.73m2 (HR: 7.9, 95% CI: 2.7-22.9, P < 0.001), LAD ≥ 50 mm (HR: 4.8, 95% CI: 1.9-12.5, P = 0.001), and male sex (HR: 3.9, 95% CI: 1.5-10.3, P = 0.006) were the strongest risk markers. All patients with 3 risk factors experienced HFH within 2 years, whereas none of 25 patients without any risk factors experienced the endpoint during 113 patient years of follow-up. Conclusions Response to 'ablate and pace' therapy in patients with AF and HF is variable and can be stratified by risk. The eGFR ≤ 60 mL/min/1.73m2, LAD ≥ 50 mm, and male sex were strong predictors of poor therapeutic outcomes. Patients without any of these risk factors had minimal HFH risk, whereas ≥ 2 risk factors increased the risk dramatically. This may help to make decisions on selection of appropriate individuals for this combined treatment.
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Shen et al. (2026) conducted a cohort in Atrial fibrillation and symptomatic heart failure (n=98). Baseline risk factors (eGFR ≤ 60 mL/min/1.73m², LAD ≥ 50 mm, male sex) in patients undergoing LBBAP and AVN ablation vs. Absence of risk factors (eGFR > 60 mL/min/1.73m², LAD < 50 mm, female sex) was evaluated on Heart failure hospitalization (HFH) (HR 7.9, 95% CI 2.7-22.9, p=<0.001). In LBBAP with AVN ablation for AF and HF, eGFR ≤60, LAD ≥50 mm, and male sex predicted heart failure hospitalization.
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