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Feasibility and safety of both His bundle pacing and left bundle branch area pacing in atrial fibrillation patients: intermediate term follow-up

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Abstract

Purpose

His bundle pacing (HBP) improves heart failure (HF) in atrial fibrillation (AF) pacing–dependent patients with a potential for a progressively increased threshold. HBP with right ventricular pacing (RVP) as a backup is always the preferred choice; however, RVP may induce HF. His Purkinje system pacing (HPSP) includes HBP and left bundle branch area pacing (LBBAP). LBBAP maintains left ventricular synchrony but has not been proven to be safe over the long term. We assessed the feasibility and safety of both HBP and LBBAP in AF pacing–dependent patients and compared the parameters of both leads at baseline and at the 6-month follow-up.

Methods

A total of 16 AF patients in our center, who successfully attempted both HBP and LBBAP, were prospectively enrolled unless only one of these treatment statuses was attained. The electrocardiogram characteristics, leading parameters, echocardiography results, and clinical outcomes were assessed.

Results

Thirteen out of 16 patients achieved both HBP and LBBAP successfully in the same AF pacing–dependent patients. In symptomatic HF patients with preserved left ventricular ejection fraction (LVEF) (n = 10), the left ventricular end-diastolic diameter (LVEDD) was reduced from 51.8 ± 4.4 to 48.3 ± 3.1 mm (p = 0.01) with the use of diuretics, either reduced or stopped (n = 7). During the follow-up, one patient in the group without HF had an increased HBP threshold and developed HF symptoms. His HF symptoms disappeared when switched into LBBAP mode. Another patient in the group with HF got his LVEF elevated by HBP for 3 months by utilizing left bundle branch block(LBBB)correction and continued to increase when switched into LBBAP for another 3 months due to an increased HBP correction threshold. The average unipolar pacing threshold of LBBAP was lower than that of HBP. No perforation or dislodgement occurred in our study.

Conclusion

Both HBP and LBBAP could be attempted successfully in the same AF patients when one of the two modes could be adopted and switched according to the clinical feasibility. Compared with HBP, LBBAP yielded better and more stable parameters but showed comparable effects during the 6-month follow-up.

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Acknowledgements

We thank Weijian Huang, MD, PhD, for sharing his experience in His bundle pacing and left bundle area pacing with us. We thank Dr. Derek from UK for his help in English writing, editing, and thoughtful review of the manuscript. We would like to thank anonymous reviewers for comments on earlier drafts.

Funding

This work was supported by the funding from Clinical research project of Zhejiang Medical Association (no. 2016ZYC-A28).

Author information

Authors and Affiliations

  1. Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, Zhejiang, People’s Republic of China

    Yang Ye, Kai Zhang, Ying Yang, Dongmei Jiang, Yiwen Pan, **a Sheng, Zuwen Zhang, Jiefang Zhang, Li Wang, Jiangfen Jiang, Yaxun Sun, Qiang Liu, Min Wang, Hong He, Chenyang Jiang & Guosheng Fu

  2. Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, Zhejiang, People’s Republic of China

    Bei Wang & Chan Yu

  3. Department of Cardiology, The Second People’s Hospital of Quzhou, No.338 **afei Road, 324000, Quzhou, Zhejiang, People’s Republic of China

    Yunxian Cheng

  4. Department of Cardiology, Zhejiang Rongjun Hospital, No. 309 Shuang Yuan Road, Jiaxing, 314000, Zhejiang, People’s Republic of China

    Bo Gao

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Correspondence to Guosheng Fu.

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Ye, Y., Zhang, K., Yang, Y. et al. Feasibility and safety of both His bundle pacing and left bundle branch area pacing in atrial fibrillation patients: intermediate term follow-up. J Interv Card Electrophysiol 66, 271–280 (2023). https://doi.org/10.1007/s10840-021-00964-6

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