Tong Fei, Sun Zhijun
Department of Cardiology, Shengjing Hospital, China Medical University, Shenyang, China.
Front Cardiovasc Med. 2022 Feb 24;9:829733. doi: 10.3389/fcvm.2022.829733. eCollection 2022.
His-Purkinje system pacing (HPSP) combined with atrioventricular node ablation is an effective therapy for atrial fibrillation (AF) patients with heart failure (HF). However, atrioventricular node ablation has some limitations and disadvantages. HPSP combined with β -blockers reduces intrinsic heart rate and increases pacing proportion, which may be an alternative to HPSP combined with atrioventricular node ablation. This study was to assess the therapeutic effect of different HPSP proportion on AF patients with HF.
The study enrolled 30 consecutive persistent AF patients with HF who underwent HPSP. Heart rate was controlled by medical therapy. NYHA class, NT-proBNP, echocardiographic parameters were assessed at follow-up. MACE was defined as the composite endpoint of readmission for HF and cardiac mortality.
The AUC of pacing proportion for predicting MACE was 0.830 (SE = 0.140, 95%CI:0.649-0.941, = 0.018), the optimal cut-off point of pacing proportion to predict MACE by ROC analysis was 71% (sensitivity:83.3%, specificity: 91.7%). In high pacing proportion group (>71%), there were significant improvements of NYHA class, NT-proBNP, LVEF and LVEDD from the baseline in wide QRS complex (QRSd>120 ms) patients and HFrEF patients at half year follow-up, and there were significant improvements in NYHA class, NT-proBNP from baseline in narrow QRS complex (QRSd ≤ 120 ms) patients and HFpEF patients at half year follow-up, moderate but no significant improvements of LVEF and LVEDD were observed in these patients. In low pacing proportion group (≤ 71%), there were no significant improvements of NT-proBNP, LVEDD or LVEF regardless of baseline QRS duration or LVEF ( > 0.05).
High pacing proportion (>71%) of HPSP can improve clinical outcomes and echocardiographic parameters in persistent AF patients with wide QRS complex or HFrEF, and clinical outcomes in persistent AF patients with narrow QRS complex or HFpEF. High pacing proportion of HPSP has a beneficial effect on the prognosis of persistent AF patients with HF.
希氏束-浦肯野系统起搏（HPSP）联合房室结消融是心力衰竭（HF）合并心房颤动（AF）患者的一种有效治疗方法。然而，房室结消融存在一些局限性和缺点。HPSP联合β受体阻滞剂可降低固有心率并提高起搏比例，这可能是HPSP联合房室结消融的一种替代方法。本研究旨在评估不同HPSP比例对HF合并AF患者的治疗效果。
本研究纳入了30例连续接受HPSP的持续性AF合并HF患者。通过药物治疗控制心率。在随访时评估纽约心脏协会（NYHA）心功能分级、N末端B型利钠肽原（NT-proBNP）、超声心动图参数。主要不良心血管事件（MACE）定义为因HF再次入院和心脏死亡的复合终点。
起搏比例预测MACE的曲线下面积（AUC）为0.830（标准误=0.140，95%可信区间：0.649-0.941，P=0.018），通过ROC分析预测MACE的起搏比例最佳截断点为71%（敏感性：83.3%，特异性：91.7%）。在高起搏比例组（>71%）中，宽QRS波群（QRSd>120 ms）患者和射血分数降低的心力衰竭（HFrEF）患者在半年随访时，NYHA心功能分级、NT-proBNP、左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）较基线有显著改善，窄QRS波群（QRSd≤120 ms）患者和射血分数保留的心力衰竭（HFpEF）患者在半年随访时，NYHA心功能分级、NT-proBNP较基线有显著改善，这些患者的LVEF和LVEDD有中度但无显著改善。在低起搏比例组（≤71%）中，无论基线QRS波持续时间或LVEF如何，NT-proBNP、LVEDD或LVEF均无显著改善（P>0.05）。
高起搏比例（>71%）的HPSP可改善宽QRS波群或HFrEF的持续性AF患者的临床结局和超声心动图参数，以及窄QRS波群或HFpEF的持续性AF患者的临床结局。高起搏比例的HPSP对HF合并持续性AF患者的预后有有益影响。
