title: Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction.
abstract: BACKGROUND
  Clinical benefits from His bundle pacing (HBP) in heart failure patients with preserved and reduced left ventricular ejection fraction are still inconclusive. This study evaluated clinical outcomes of permanent HBP in atrial fibrillation patients with narrow QRS who underwent atrioventricular node ablation for heart failure symptoms despite rate control by medication.
  
  
  RESULTS
  The study enrolled 52 consecutive heart failure patients who underwent attempted atrioventricular node ablation and HBP for symptomatic atrial fibrillation. Echocardiographic left ventricular ejection fraction and left ventricular end-diastolic dimension, New York Heart Association classification and use of diuretics for heart failure were assessed during follow-up visits after permanent HBP. Of 52 patients, 42 patients (80.8%) received permanent HBP and atrioventricular node ablation with a median 20-month follow-up. There was no significant change between native and paced QRS duration (107.1±25.8 versus 105.3±23.9 milliseconds,P=0.07). Left ventricular end-diastolic dimension decreased from the baseline (P<0.001), and left ventricular ejection fraction increased from baseline (P<0.001) in patients with a greater improvement in heart failure with reduced ejection fraction patients (N=20) than in heart failure with preserved ejection fraction patients (N=22). New York Heart Association classification improved from a baseline 2.9±0.6 to 1.4±0.4 after HBP in heart failure with reduced ejection fraction patients and from a baseline 2.7±0.6 to 1.4±0.5 after HBP in heart failure with preserved ejection fraction patients. After 1 year of HBP, the numbers of patients who used diuretics for heart failure decreased significantly (P<0.001) when compared to the baseline diuretics use.
  
  
  CONCLUSIONS
  Permanent HBP post-atrioventricular node ablation significantly improved echocardiographic measurements and New York Heart Association classification and reduced diuretics use for heart failure management in atrial fibrillation patients with narrow QRS who suffered from heart failure with preserved or reduced ejection fraction.
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China weijianhuang69@126.com.|The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.
authors.forename: Weijian
authors.initials: W
authors.lastname: Huang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Su
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China.
authors.forename: Fangyi
authors.initials: F
authors.lastname: Xiao
authors.affiliation: Cardiac Rhythm and Heart Failure Division, Medtronic, Mounds View, MN.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Cardiology, Virginia Commonwealth University Health System, Richmond, VA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D002036:Bundle of His; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume
keywords: His bundle pacing; atrial fibrillation; atrioventricular node ablation; heart failure