Conduction System Pacing Versus Biventricular Pacing After Atrioventricular Node Ablation

Summary

Atrioventricular node ablation (AVNA) with biventricular (BiV) pacemaker implantation is a feasible treatment option in patients with symptomatic refractory atrial fibrillation and heart failure. However, conduction system pacing (CSP) modalities, including His bundle pacing and left bundle branch pacing, could offer advantages over BiV pacing by providing more physiological activation. The randomized, interventional, multicentric study will explore whether CSP is non-inferior to BiV pacing in echocardiographic and clinical outcomes in heart failure (EF \<50%) patients with symptomatic AF and narrow QRS scheduled for AVNA.

Eligibility

Inclusion Criteria:

1. Symptomatic permanent atrial fibrillation, refractory to drug therapy or failed catheter ablation
2. Left ventricular ejection fraction \<50%
3. Narrow intrinsic QRS ≤ 120 ms
4. NT-proBNP \> 600 ng/L
5. Patient has provided written informed consent
6. Age between 18 years and 85 years

Exclusion Criteria:

1. Pre-existing permanent pacemaker, implantable cardioverter-defibrillator or cardiac resynchronization device. Patients who had devices implanted that had \<5% of paced beats (i.e., backup pacing) can be enrolled.
2. Life expectancy less than 12 months
3. Severe concomitant non-cardiac disease
4. Pregnancy
5. Recent (\<3 months) myocardial infarction, percutaneous or surgical myocardial revascularization
6. Significant heart valve disease (severe insufficiency or stenosis)
7. Contraindication for oral anticoagulation
8. Mechanical tricuspid valve replacement
9. Unwillingness to participate or lack of availability for follow-up

Conditions4

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