His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with major clinical benefits
His-bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and atrioventricular nodal ablation (AVNA) because it preserves physiological ventricular activation. Only limited data regarding HBP combined with AVNA are available...
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| Veröffentlicht in: | Heart rhythm 2023-04, Vol.20 (4), p.530-536 |
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| creator | Chaumont, Corentin Auquier, Nathanael Milhem, Antoine Mirolo, Adrian Arnaout, Alain Al Popescu, Elena Algrin, Alix Dupasquier, Valentin Viart, Guillaume Godin, Bénédicte Savouré, Arnaud Eltchaninoff, Hélène Anselme, Frédéric |
| description | His-bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and atrioventricular nodal ablation (AVNA) because it preserves physiological ventricular activation. Only limited data regarding HBP combined with AVNA are available in the literature.
The purpose of this study was to provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.
We prospectively included all patients who had undergone AVNA after HBP in 3 different hospitals between 2017 and 2022.
AVNA following HBP lead implantation was performed in 75 patients. Complete atrioventricular (AV) block was obtained in 58 patients (77%), and significant modulation of AV nodal conduction (heart rate |
| doi_str_mv | 10.1016/j.hrthm.2022.12.022 |
| format | Article |
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The purpose of this study was to provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.
We prospectively included all patients who had undergone AVNA after HBP in 3 different hospitals between 2017 and 2022.
AVNA following HBP lead implantation was performed in 75 patients. Complete atrioventricular (AV) block was obtained in 58 patients (77%), and significant modulation of AV nodal conduction (heart rate <60 bpm) was obtained in 12 patients (16%). AVNA failure was observed in 5 patients (7%). Recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure than in patients with complete AV block (11/17 vs 5/58; P <.001). No lead dislodgment occurred during the AVNA procedures. Acute His-bundle (HB) capture threshold increase >1 V occurred in 11 patients (15%), with return to baseline value on day 1 in 9 patients. New York Heart Association functional class and left ventricular ejection fraction significantly improved from baseline to last follow-up (3.0 ± 0.7 vs 1.6 ± 0.5; P <.001; and 47% ± 14% vs 60% ± 9%; P <.0001, respectively).
AVNA combined with HBP for noncontrolled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2022.12.022</identifier><identifier>PMID: 36549630</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arrhythmia ; Atrial fibrillation ; Atrial Fibrillation - surgery ; Atrioventricular Block ; Atrioventricular nodal ablation ; Bundle of His ; Cardiac Pacing, Artificial - methods ; His-bundle pacing ; Humans ; Rate control ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>Heart rhythm, 2023-04, Vol.20 (4), p.530-536</ispartof><rights>2023</rights><rights>Copyright © 2023. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c404t-72692e085373b51c75c9c1acee87efc1241c8e368972f79db1f46c1cdadb9bc3</citedby><cites>FETCH-LOGICAL-c404t-72692e085373b51c75c9c1acee87efc1241c8e368972f79db1f46c1cdadb9bc3</cites><orcidid>0000-0002-2130-9790</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hrthm.2022.12.022$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36549630$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chaumont, Corentin</creatorcontrib><creatorcontrib>Auquier, Nathanael</creatorcontrib><creatorcontrib>Milhem, Antoine</creatorcontrib><creatorcontrib>Mirolo, Adrian</creatorcontrib><creatorcontrib>Arnaout, Alain Al</creatorcontrib><creatorcontrib>Popescu, Elena</creatorcontrib><creatorcontrib>Algrin, Alix</creatorcontrib><creatorcontrib>Dupasquier, Valentin</creatorcontrib><creatorcontrib>Viart, Guillaume</creatorcontrib><creatorcontrib>Godin, Bénédicte</creatorcontrib><creatorcontrib>Savouré, Arnaud</creatorcontrib><creatorcontrib>Eltchaninoff, Hélène</creatorcontrib><creatorcontrib>Anselme, Frédéric</creatorcontrib><title>His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with major clinical benefits</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>His-bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and atrioventricular nodal ablation (AVNA) because it preserves physiological ventricular activation. Only limited data regarding HBP combined with AVNA are available in the literature.
The purpose of this study was to provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.
We prospectively included all patients who had undergone AVNA after HBP in 3 different hospitals between 2017 and 2022.
AVNA following HBP lead implantation was performed in 75 patients. Complete atrioventricular (AV) block was obtained in 58 patients (77%), and significant modulation of AV nodal conduction (heart rate <60 bpm) was obtained in 12 patients (16%). AVNA failure was observed in 5 patients (7%). Recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure than in patients with complete AV block (11/17 vs 5/58; P <.001). No lead dislodgment occurred during the AVNA procedures. Acute His-bundle (HB) capture threshold increase >1 V occurred in 11 patients (15%), with return to baseline value on day 1 in 9 patients. New York Heart Association functional class and left ventricular ejection fraction significantly improved from baseline to last follow-up (3.0 ± 0.7 vs 1.6 ± 0.5; P <.001; and 47% ± 14% vs 60% ± 9%; P <.0001, respectively).
AVNA combined with HBP for noncontrolled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.</description><subject>Arrhythmia</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - surgery</subject><subject>Atrioventricular Block</subject><subject>Atrioventricular nodal ablation</subject><subject>Bundle of His</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>His-bundle pacing</subject><subject>Humans</subject><subject>Rate control</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1jAQhaMKRC_wBEjISzYJviRxgsSiqnpBqsSme8uZTBr_cuwf2ynqQ_DOOE1hyepY4-_M2HOK4iOjFaOs_XKo5pDmpeKU84rxKstJccaapi1FJ9mb7VzLsuGSnRbnMR4o5X1LxbviVLRN3beCnhW_70wsh9WNFslRg3GPRLuR6BSMf0KXBVarA3F-1JbowepkvCOT30oOfCa8tbg7NiKE-Tm_yuiv5JIkhNkZyHWYdcbcI5JfJs1k0YfcAazZbwd0OJkU3xdvJ20jfnjVi-Lh5vrh6q68_3H7_eryvoSa1qmUvO050q4RUgwNA9lAD0wDYidxAsZrBh2Ktusln2Q_DmyqW2Aw6nHoBxAXxee97TH4nyvGpBYTAa3VDv0aFZdNl1dcdyKjYkch-BgDTuoYzKLDs2JUbTGog3qJQW0xKMZVluz69DpgHRYc_3n-7j0D33YA8y-fDAYVwaADHE1ASGr05r8D_gBiiZ3M</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Chaumont, Corentin</creator><creator>Auquier, Nathanael</creator><creator>Milhem, Antoine</creator><creator>Mirolo, Adrian</creator><creator>Arnaout, Alain Al</creator><creator>Popescu, Elena</creator><creator>Algrin, Alix</creator><creator>Dupasquier, Valentin</creator><creator>Viart, Guillaume</creator><creator>Godin, Bénédicte</creator><creator>Savouré, Arnaud</creator><creator>Eltchaninoff, Hélène</creator><creator>Anselme, Frédéric</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2130-9790</orcidid></search><sort><creationdate>202304</creationdate><title>His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with major clinical benefits</title><author>Chaumont, Corentin ; Auquier, Nathanael ; Milhem, Antoine ; Mirolo, Adrian ; Arnaout, Alain Al ; Popescu, Elena ; Algrin, Alix ; Dupasquier, Valentin ; Viart, Guillaume ; Godin, Bénédicte ; Savouré, Arnaud ; Eltchaninoff, Hélène ; Anselme, Frédéric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c404t-72692e085373b51c75c9c1acee87efc1241c8e368972f79db1f46c1cdadb9bc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Arrhythmia</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrioventricular Block</topic><topic>Atrioventricular nodal ablation</topic><topic>Bundle of His</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>His-bundle pacing</topic><topic>Humans</topic><topic>Rate control</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chaumont, Corentin</creatorcontrib><creatorcontrib>Auquier, Nathanael</creatorcontrib><creatorcontrib>Milhem, Antoine</creatorcontrib><creatorcontrib>Mirolo, Adrian</creatorcontrib><creatorcontrib>Arnaout, Alain Al</creatorcontrib><creatorcontrib>Popescu, Elena</creatorcontrib><creatorcontrib>Algrin, Alix</creatorcontrib><creatorcontrib>Dupasquier, Valentin</creatorcontrib><creatorcontrib>Viart, Guillaume</creatorcontrib><creatorcontrib>Godin, Bénédicte</creatorcontrib><creatorcontrib>Savouré, Arnaud</creatorcontrib><creatorcontrib>Eltchaninoff, Hélène</creatorcontrib><creatorcontrib>Anselme, Frédéric</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chaumont, Corentin</au><au>Auquier, Nathanael</au><au>Milhem, Antoine</au><au>Mirolo, Adrian</au><au>Arnaout, Alain Al</au><au>Popescu, Elena</au><au>Algrin, Alix</au><au>Dupasquier, Valentin</au><au>Viart, Guillaume</au><au>Godin, Bénédicte</au><au>Savouré, Arnaud</au><au>Eltchaninoff, Hélène</au><au>Anselme, Frédéric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with major clinical benefits</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2023-04</date><risdate>2023</risdate><volume>20</volume><issue>4</issue><spage>530</spage><epage>536</epage><pages>530-536</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>His-bundle pacing (HBP) is an appealing alternative to right ventricular pacing in patients referred for permanent ventricular pacing and atrioventricular nodal ablation (AVNA) because it preserves physiological ventricular activation. Only limited data regarding HBP combined with AVNA are available in the literature.
The purpose of this study was to provide further evidence on the feasibility and efficacy of this therapeutic approach in patients with uncontrolled atrial arrhythmia.
We prospectively included all patients who had undergone AVNA after HBP in 3 different hospitals between 2017 and 2022.
AVNA following HBP lead implantation was performed in 75 patients. Complete atrioventricular (AV) block was obtained in 58 patients (77%), and significant modulation of AV nodal conduction (heart rate <60 bpm) was obtained in 12 patients (16%). AVNA failure was observed in 5 patients (7%). Recording of an atrial signal by the HBP lead was more frequently observed in patients with AVNA modulation/failure than in patients with complete AV block (11/17 vs 5/58; P <.001). No lead dislodgment occurred during the AVNA procedures. Acute His-bundle (HB) capture threshold increase >1 V occurred in 11 patients (15%), with return to baseline value on day 1 in 9 patients. New York Heart Association functional class and left ventricular ejection fraction significantly improved from baseline to last follow-up (3.0 ± 0.7 vs 1.6 ± 0.5; P <.001; and 47% ± 14% vs 60% ± 9%; P <.0001, respectively).
AVNA combined with HBP for noncontrolled atrial arrhythmia was feasible and clinically efficient. Implanting the HB lead on the ventricular aspect of the tricuspid annulus avoiding atrial signal recording can facilitate AVNA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36549630</pmid><doi>10.1016/j.hrthm.2022.12.022</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2130-9790</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Heart rhythm, 2023-04, Vol.20 (4), p.530-536 |
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| subjects | Arrhythmia Atrial fibrillation Atrial Fibrillation - surgery Atrioventricular Block Atrioventricular nodal ablation Bundle of His Cardiac Pacing, Artificial - methods His-bundle pacing Humans Rate control Stroke Volume Treatment Outcome Ventricular Function, Left |
| title | His-bundle pacing and atrioventricular nodal ablation for noncontrolled atrial arrhythmia: A technical challenge with major clinical benefits |
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