Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Indications D-PO02 - Poster Session II (ID 47) Poster

D-PO02-114 - Beneficial Effects Of His Bundle Pacing In Patients With Atrial Fibrillation And Bradycardia (ID 211)


Background: In patients who have an indication for permanent pacing and have an expectation of a high rate of ventricular stimulation, more physiologic ventricular activation by the use of His bundle pacing (HBP) may have a beneficial effect on the left ventricle (LV) function.
Objective: The study aims to evaluate the effect of HBP on LV function in patients with atrial fibrillation (AF) and bradycardia, depending on LV function at baseline.
Methods: A total of 135 consecutive patients with AF and bradycardia and with successfully achieved HBP were included in the study. The clinical and echocardiographic evaluation was performed at a baseline and after five to 15 months of follow-up at the outpatient clinic.
Results: A total of 73 patients, 19 of them females, aged 72.8±8.5, completed the follow-up period of an average of 7.7±2.5 months. Thirty-five of them had low LV ejection fraction (EF) below 51%, and 38 had normal LV EF over 50%, meaning EF of 60.4±6.0 and 39.1±8.4, respectively; p<0.0001. During follow-up in low-EF patients, EF increased, and end-systolic volume index (ESVi) decreased, but there was no change in EF and ESVi in patients with normal-EF at baseline, see Table. In the univariate regression analysis, the degree of the improvement of ESVi and EF in low-EF patients depended on the reduction of QRS duration and higher stimulation rate: r=0.53, p=0.003, and r=0.53, p=0.004, respectively and r=0.33, p=0.067, and r=0.51, p=0.004, respectively.
Conclusion: HBP in patients with AF and bradycardia in mid-term follow-up did not only deteriorate LV function but improved LV performance causing a reverse remodeling of LV in low-EF patients.
Normal-EF patientsLow-EF patients
At baselineAt the end of follow-upAt baselineAt the end of follow-up
EF (%)60.4±6.057.9±5.8, NS39.1±8.444.9±11.6; p=0.0164
ESVi (ml)25.0±8.725.1±6.7, NS53.1±20.445.2±21.7, p=0.0112
QRS duration (ms)98.2±13.3114.4±25.7, p=0.0083143.4±41.9119.4±21.9, p=0.0085
Non-selective HBP - % of cases4255
EF - left ventricle ejection fraction, ESVi - left ventricle end-systolic volume index