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Single-center experience of efficacy and safety of atrioventricular node ablation after left bundle branch area pacing for the management of atrial fibrillation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Atrioventricular node ablation (AVNA) with permanent pacing is an effective treatment of symptomatic atrial fibrillation (AF). Left bundle branch area pacing (LBBAP) prevents cardiac dyssynchrony associated with right ventricular pacing and could prevent worsening of heart failure (HF).

Methods

In this retrospective monocentric study, all patients who received AVNA procedure with LBBAP were consecutively included. AVNA procedure data, electrical and echocardiographic parameters at 6 months, and clinical outcomes at 1 year were studied and compared to a matched cohort of patients who received AVNA procedure with conventional pacing between 2010 and 2023.

Results

Seventy-five AVNA procedures associated with LBBAP were studied. AVNA in this context was feasible, with a success rate of 98.7% at first ablation, and safe without any complications. There was no threshold rise at follow-up. At 1 year, 6 (8%) patients were hospitalized for HF and 2 (2.7%) were deceased. Patients had a significant improvement in NYHA class and left ventricular ejection fraction (LVEF) (P ≤ 0.0001). When compared to a matched cohort of patients with AVNA and conventional pacing, AVNA data and pacing complications rates were similar. Patients with LBBAP had a better improvement of LVEF (+5.27 ± 9.62% vs. −0.48 ± 14%, P = 0.01), and a lower 1-year rate of composite outcome of hospitalization for HF or death (HR 0.39, 95% CI: 0.16–0.95, P = 0.037), significant on survival analysis (log-rank P-value = 0.03).

Conclusion

AVNA with LBBAP in patients with symptomatic AF is feasible, safe, and efficient. Hospitalization for HF or death rate was significantly lower and LVEF improvement was greater.

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Authors and Affiliations

  1. University Hospital of Tours, Avenue de la république, Chambray-Les-Tours, 37170, France

    Mathieu Jacobs, Alexandre Bodin, Dominique Babuty & Arnaud Bisson

  2. University Hospital of Orleans, 14 Avenue de l’Hopital, Orleans, 45100, France

    Pascal Spiesser & Arnaud Bisson

  3. Clinic du Millenaire, 220 Boulevard Penelope, Montpellier, 34000, France

    Nicolas Clementy

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Jacobs, M., Bodin, A., Spiesser, P. et al. Single-center experience of efficacy and safety of atrioventricular node ablation after left bundle branch area pacing for the management of atrial fibrillation. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01847-2

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