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.