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His Bundle Pacing Combined With Atrioventricular Node Ablation-A Novel Treatment of Atrial Fibrillation Patients With Heart Failure
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  • Xinmiao Luo,
  • Lu Zhang,
  • Chaoqun Huang,
  • Shuyan Li
Xinmiao Luo
Jilin University First Hospital
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Lu Zhang
Jilin University First Hospital
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Chaoqun Huang
Jilin University First Hospital
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Shuyan Li
Jilin University First Hospital

Corresponding Author:[email protected]

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Abstract

Atrial fibrillation patients with heart failure often have the worst prognosis. Pacing combined with atrioventricular node ablation (AVNA) is often the last resort in patients with atrial fibrillation (AF) and heart failure (HF) who are refractory to medication therapy or AF catheter ablation, especially in those with other arrhythmias that need pacemaker therapy. His bundle pacing is a physiologic pacing option for patients undergoing AVNA, which prevents the adverse consequences of right ventricular pacing and enhances the response rate compared with biventricular pacing (BVP). Several studies have proven the clinical benefits, feasibility and efficacy of His bundle pacing combined with atrioventricular node ablation in patients with AF and HF. However, this must be confirmed in large randomized clinical trials. Due to HBP limitations of difficulty in implantation, lower success rates in patients with QRS prolongation, and high and unstable pacing capture threshold, the concept of left bundle branch pacing has been proposed in recent years. In this review, we discussed the epidemiology of atrial fibrillation and heart failure, their interrelations, current treatment for patients with AF and HF and focus on the role and current evidence for His bundle pacing combined with atrioventricular node ablation in patients with AF and HF.