Therapeutic Effect of His-Purkinje System Pacing Proportion on
Persistent Atrial Fibrillation Patients With Heart Failure
Abstract
Background His-Purkinje system pacing(HPSP) combined with
atrioventricular node (AVN) ablation is an effective therapy for atrial
fibrillation (AF) patients with heart failure (HF).However, AVN ablation
is accompanied with some limitations and disadvantages. HPSP combined
with β -blocker reduces inherent heart rate and increases pacing ratio,
which may be an alternative to HPSP combined with AVN ablation. This
study was to assess the therapeutic effect of different His-Purkinje
system pacing proportions on AF patients with HF. Methods The study
enrolled 30 consecutive persistent AF patients with HF who underwent
HPSP. Heart rate was controlled by medical therapy. New York Heart
Association (NYHA) classification, serum NT-proBNP concentration,
echocardiographic parameters were assessed at each follow-up. Results
The best cut-off value of pacing proportion to predict MACE by ROC
analysis was 71%. In high pacing proportion group, there were
significant improvements of NYHA classification, NT-proBNP
concentration, LVEF and LVEDD from the baseline in wide QRS complex
patients and HFrEF patients, and there were significant improvements in
NYHA classification, NT-proBNP concentration from baseline in narrow QRS
complex patients and HFpEF patients, moderate but no significant
improvements of LVEF and LVEDD were observed in those patients groups.
In low pacing proportion group, there were no significant improvements
of NT-proBNP concentration, LVEDD or LVEF regardless of baseline QRS
duration or LVEF (P > 0.05). Conclusion High pacing
proportion of HPSP has a beneficial effect on the prognosis of
persistent AF patients with heart failure.