Conduction system pacing versus conventional pacing in patients undergoing atrioventricular node ablation: Nonrandomized, on-treatment comparison

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 AVNA was performed in 223 patients (CSP, 110; CP, 113). Age was 75 +/- 10 years, male 52%, hypertension 67%, diabetes 25%, coronary disease 40%, and left ventricular ejection fraction (LVEF) 43% +/- 15%. QRS duration increased from 103 +/- 30 ms to 124 +/- 20 ms (P,.01) in CSP and 119 +/- 32 ms to 162 +/- 24 ms in CP (P <.001). During a mean follow-up of 27 +/- 19 months, LVEF significantly increased from 46.5% +/- 14.2% to 51.9% +/- 11.2% (P = .02) in CSP and 36.4% +/- 16.1% to 39.5% +/- 16% (P =.04) in CP. The primary combined endpoint of time to death or HFH was significantly reduced in CSP compared to CP (48% vs 62%; hazard ratio 0.61, 95% confidence interval 0.42-0.89, P,.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.

Automated summary

This study compares the clinical outcomes of conventional pacing (CP) and conduction system pacing (CSP) in patients undergoing atrioventricular node ablation (AVNA). The results show that CSP can significantly reduce the combined endpoint of death or heart failure hospitalization.