A Case Series of Combined His Bundle and Left Bundle Branch Area Pacing Prior to Atrioventricular Node Ablation for Troublesome Atrial Fibrillation in Patients With Normal Ejection Fraction: Should we Default to a Deep Septal Approach?

2021 ◽  
Vol 30 ◽  
pp. S144
Author(s):  
M. Nam ◽  
P. O'Sullivan ◽  
G. Lee ◽  
G. Wynn ◽  
B. Moore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Case Series ◽  
Atrioventricular Node ◽  
Normal Ejection Fraction ◽  
His Bundle

Atrioventricular nodal conduction during atrial fibrillation in rabbit heart

1982 ◽  
Vol 243 (5) ◽  
pp. H754-H760 ◽  
Author(s):  
T. Mazgalev ◽  
L. S. Dreifus ◽  
J. Bianchi ◽  
E. L. Michelson
Keyword(s):  
Atrial Fibrillation ◽  
Action Potentials ◽  
Atrioventricular Node ◽  
Interatrial Septum ◽  
Rabbit Heart ◽  
Relative Timing ◽  
Crista Terminalis ◽  
His Bundle ◽  
Atrioventricular Nodal Conduction ◽  
Variable Interaction

Atrial fibrillation was induced in 15 superfused rabbit atrial-atrioventricular nodal preparations in which surface bipolar electrograms were recorded simultaneously from the crista terminalis, interatrial septum, and His bundle along with microelectrode action potentials from cells in the atrionodal (AN), nodal (N), and nodal-His (NH) regions of the atrioventricular node. Effective engagement of the atrioventricular node with propagation to the His bundle was critically dependent on the relative timing of activation at the crista terminalis and interatrial septal input regions of the atrioventricular node. Conduction through the AN and N regions appeared dependent on the relative timing of activation wave fronts emerging from the two input regions. Asynchronous engagement of AN and N regions resulted in both distortion of action potentials and concealed conduction, with delayed conduction and block to the NH region and His bundle. Successful engagement of the NH region always produced a 1:1 NH-to-His bundle relationship. It is concluded that during atrial fibrillation 1) activation of the AN region occurs as a result of the variable interaction of inputs from the crista terminalis and interatrial septum; 2) predictably, effective synchronous engagement of the AN and consequently the N region is responsible for conduction to the NH and His bundle regions; 3) conversely, asynchronous activation inputs from the crista terminalis and interatrial septum result in fragmented, asynchronous as well as concealed conduction within the AN and N regions with block in the atrioventricular node and variable conduction to the His bundle.

Impact of Atrial Fibrillation in Heart Failure With Normal Ejection Fraction: A Clinical and Echocardiographic Study

2007 ◽  
Vol 13 (8) ◽  
pp. 649-655 ◽  
Author(s):  
Jeffrey W.H. Fung ◽  
John E. Sanderson ◽  
Gabriel W.K. Yip ◽  
Qing Zhang ◽  
Cheuk M. Yu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Normal Ejection Fraction ◽  
Echocardiographic Study

scholarly journals A case of atrioventricular junction ablation and permanent left bundle branch pacing for patient with refractory atrial fibrillation and hypertrophic cardiomyopathy

2020 ◽  
Author(s):  
Ning Zhang ◽  
Shan Liu ◽  
Shou Zhang ◽  
Yan Wei ◽  
Le Xie ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Rate Control ◽  
Atrioventricular Node ◽  
Clinical Effectiveness ◽  
Atrioventricular Junction ◽  
His Bundle ◽  
Pace Maker

Atrioventricular node ablation (AVNA) combined with His bundle pacing (HBP) are feasible, safe, and effective in patients with refractory atrial fibrillation (AF), however, the pacing parameters of sensing and capture threshold maybe sometimes unsatisfactory. Left bundle branch pacing (LBBP) provides obvious advantage in patients with conduction diseases at the distal His bundle for its better sensing, a lower and more stable capture threshold. Among hypertrophic cardiomyopathy (HCM) patients, AF is a common sustained arrhythmia, primarily caused by left atrial dilatation and remodeling. Few is known about the feasibility of electrophysiological performance, safety and clinical effectiveness of atrioventricular junction ablation (AVJA) combined with LBBP in patient with refractory AF and HCM. Here, we report a case of a 56-year-old woman suffering from refractory AF and HCM, however HBP was failed for its unsatisfactory sensing, a high and unstable capture threshold for her, therefore, ablation and LBBB were accepted by her to achieve better rate control. Improvement in symptoms, quality of life, and exercise capacity has been observed during the 1.5-year follow-up. To our knowledge, our case originally confirmed that the combination of AVJA and LBBP, without the defect of AVNA combined with HBP, is a better strategy with feasibility and safety for refractory AF patients with comorbidity of HCM, additionally, it may make LBBP more applicable and valuable among patients suffering from HCM meanwhile pace maker treatments are essential.

scholarly journals 480 Catheter pulmonary vein ablation vs. medical therapy or atrioventricular node ablation and resynchronization in patients with atrial fibrillation and heart failure: a systematic review and meta-analysis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gaetano Liccardo ◽  
Francesco Cannata ◽  
Mauro Chiarito ◽  
Sara Bombace ◽  
Marta Maccallini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Pulmonary Vein ◽  
Medical Therapy ◽  
Randomized Clinical Trials ◽  
Atrioventricular Node ◽  
Reduced Ejection Fraction

Abstract Aims Atrial fibrillation (AF) and heart failure (HF) are increasing in prevalence worldwide and, when present altogether, are associated with significant mortality and morbidity. Several and recent randomized clinical trials have reported an improvement of clinical outcomes in patients with HF and AF with catheter ablation. To provide a comprehensive and updated synthesis of effect estimates of the available randomized and observational clinical trials comparing pulmonary vein isolation with optimal medical therapy (rate or rhythm) or atrioventricular node ablation and resynchronization. Methods and results MEDLINE database was searched from inception to 4 March 2021 by two reviewers (F.C. and M.C.) for relevant studies. The following key words were used: ‘atrial fibrillation’, ‘heart failure’, ‘ablation’, ‘medical’, ‘drug’, ‘rate’, ‘rhythm’, ‘resynchronization’, and ‘atrial flutter’. The co-primary outcomes were all-cause death and hospitalization for HF. A total of 16 studies enrolling 42 908 patients were included; of these, 9 were randomized controlled trials, 3 unadjusted observational studies, and 4 adjusted observational trials. Patients treated with catheter ablation had a statistically significant reduction for the risk of all-cause death {Figure on the left: odds ratio [OR]: 0.51, [95% confidence interval (CI): 0.31–0.84], P = 0.008, NNT 33} and hospitalization for HF [Figure on the right: OR: 0.52, (95% CI: 0.31–0.87), P 0.014, NNT 24]. Subgroup analysis confirmed these results only in HF with reduced ejection fraction subgroup. Meta-regression analyses showed a direct correlation between a higher burden of persistent/long-standing persistent AF and the positive impact of catheter ablation of AF. Moreover, the age of 70 years emerged as the cut-off age for a greater impact of catheter ablation. Conclusions Catheter ablation of AF is associated with a lower risk of all-cause death and HF hospitalizations in patients with AF and HF, as compared to medical therapy or atrioventricular node ablation and resynchronization. These results are mainly applicable for HF with reduced ejection fraction.

Sign in / Sign up

Export Citation Format

Share Document