Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, China.
The Key Lab of Cardiovascular Disease of Wenzhou, Science and Technology of Wenzhou, Wenzhou, China.
Europace. 2020 Dec 26;22(Suppl_2):ii19-ii26. doi: 10.1093/europace/euaa306.
His-bundle pacing (HBP) combined with atrioventricular node (AVN) ablation has been demonstrated to be effective in patients with atrial fibrillation (AF) and heart failure (HF) during medium-term follow-up and there are limited data on the risk analysis of adverse prognosis in this population. In this study, we aimed to evaluate the long-term performance of HBP following AVN ablation in AF and HF.
From August 2012 to December 2017, consecutive AF patients with HF and narrow QRS who underwent AVN ablation and HBP were enrolled. The clinical and echocardiographic data, pacing parameters, all-cause mortality, and heart failure hospitalization (HFH) were tracked. A total of 94 patients were enrolled (age 70.1 ± 10.5 years; male 57.4%). Acute HBP were achieved in 89 (94.7%) patients with successful permanent HBP combined with AVN ablation in 81 (86.2%) patients. Left ventricular ejection fraction (LVEF) improved from 44.9 ± 14.9% at baseline to 57.6 ± 12.5% during a median follow-up of 3.0 (IQR: 2.0-4.4) years (P < 0.001). Heart failure hospitalization or all-cause mortality occurred in 21 (25.9%) patients. The LVEF ≤ 40%, pulmonary artery systolic pressure (PASP) ≥40 mmHg, or serum creatinine (Scr) ≥97 μmol/L at baseline was significantly associated with higher composite endpoint of HFH or death (P < 0.05). The His capture threshold was 1.0 ± 0.7 V/0.5 ms at implant and remained stable during follow-up.
His-bundle pacing combined with AVN ablation was effective in patients with AF and drug-refectory HF. High PASP, high Scr, or low LVEF at baseline was independent predictors of composite endpoint of all-cause mortality or HFH.
希氏束起搏（HBP）联合房室结（AVN）消融已被证明在房颤（AF）和心力衰竭（HF）患者的中期随访中是有效的，而关于该人群不良预后风险分析的数据有限。在这项研究中，我们旨在评估 AVN 消融后 HBP 在 AF 和 HF 中的长期表现。
从 2012 年 8 月至 2017 年 12 月，连续纳入接受 AVN 消融和 HBP 的 AF 合并 HF 且 QRS 波群狭窄的患者。跟踪临床和超声心动图数据、起搏参数、全因死亡率和心力衰竭住院（HFH）。共纳入 94 例患者（年龄 70.1±10.5 岁；男性 57.4%）。89 例（94.7%）患者实现了急性 HBP，81 例（86.2%）患者成功进行了永久性 HBP 联合 AVN 消融。左心室射血分数（LVEF）从基线时的 44.9±14.9%改善至中位数 3.0（IQR：2.0-4.4）年随访时的 57.6±12.5%（P<0.001）。21 例（25.9%）患者发生 HFH 或全因死亡率。基线时 LVEF≤40%、肺动脉收缩压（PASP）≥40mmHg 或血清肌酐（Scr）≥97μmol/L 与 HFH 或死亡的复合终点发生率较高显著相关（P<0.05）。植入时 His 捕获阈值为 1.0±0.7V/0.5ms，在随访期间保持稳定。
HBP 联合 AVN 消融在 AF 和药物难治性 HF 患者中是有效的。基线时高 PASP、高 Scr 或低 LVEF 是全因死亡率或 HFH 复合终点的独立预测因素。
