Safety of One-Stage Atrioventricular Junction Ablation after Pacemaker Implantation for Left Bundle Branch Pacing

  • Eugene O. Perepeka National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-9755-8825
  • Roman A. Sikhnevych National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; Zhytomyr Polytechnic State University, Zhytomyr, Ukraine https://orcid.org/0009-0001-0226-0020
DOI: https://doi.org/10.30702/ujcvs/24.32(01)/PS014-5863
Keywords: atrial fibrillation, conduction system pacing, lead dislodgement, catheter ablation, resynchronization therapy

Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias. Atrioventricular (AV) junction ablation combined with pacemaker implantation has become an accepted, effective strategy for the treatment of symptomatic tachysystolic AF resistant to drug therapy, especially in the elderly. Left bundle branch (LBB) pacing is a physiological alternative to right ventricular pacing.

The aim. This study evaluated the effectiveness and safety of a one-stage application of the implantation system for LBB pacing and ablation of the AV junction.

Materials and methods. For the period from January 2023 to February 2024, LBB pacing was applied in 8 patients at the National Amosov Institute of Cardiovascular Surgery in the context of treatment of chronic tachysystolic form of AF with subsequent ablation of the AV junction, as a strategy to control heart rate.

Results. In all the patients, LBB pacing criteria were achieved: Qr or qR in V1 QRS complex morphology type during pacing (100%); St-V6RWPT interval < 80 ms (mean 75.8 ± 13.9 ms); the difference between the intervals St-V1RWPT – St-V6RWPT > 44 ms (mean 55.57 ± 10.09 ms). In 3 out of 8 patients (37%) it was possible to register LBB potential. Mean paced QRS width in the studied group was 130 ± 18.02 ms. The mean intraoperative LBB pacing threshold was 1.71 ± 0.39 V for 0.4 ms, the anodal pacing threshold was 3.25 ± 0.5 V for 0.4 ms (we could demonstrate it in 6 out of 8 patients [75%]). Intraoperative lead perforation through the interventricular septum could be observed in 2 out of 8 cases (25%), but after that it was possible to successfully reimplant the lead in the area of the LBB. In all the patients of the studied group, it was possible to successfully perform radiofrequency ablation of the AV junction with the aim of heart rate control in chronic tachysystolic AF. There was no endocardial lead dislodgement in the postoperative period in any of the patients.

Conclusions. In the studied group, no complications and hemodynamic disturbances were observed in the acute postoperative period and during follow-up one week after the pacemaker implantation for LBB pacing and AV junction ablation. Intraoperative transseptal perforation of the endocardial lead did not complicate reimplantation of the lead in the LBB area. A single-stage pacemaker implantation for LBB pacing and AV junction ablation can significantly shorten the patient’s stay in a medical institution. The subject requires further research on a larger number of patients with long-term follow-up.

References

  1. Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217-221. https://doi.org/10.1177/1747493019897870
  2. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023;147(8):e93-e621. https://doi.org/10.1161/CIR.0000000000001123
  3. Tung R, Burri H. Role of conduction system pacing in ablate and pace strategies for atrial fibrillation. Eur Heart J Suppl. 2023;25(Suppl G):G56-G62. https://doi.org/10.1093/eurheartjsupp/suad119
  4. Huizar JF, Ellenbogen KA, Tan AY, Kaszala K. Arrhythmia-Induced Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(18):2328-2344. https://doi.org/10.1016/j.jacc.2019.02.045
  5. Tu C, Caudal A, Liu Y, Gorgodze N, Zhang H, Lam CK, et al. Tachycardia-induced metabolic rewiring as a driver of contractile dysfunction. Nat Biomed Eng. 2023 Nov 27. Epub ahead of print. https://doi.org/10.1038/s41551-023-01134-x
  6. Walters TE, Szilagyi J, Alhede C, Sievers R, Fang Q, Olgin J, et al. Dyssynchrony and Fibrosis Persist After Resolution of Cardiomyopathy in a Swine Premature Ventricular Contraction Model. JACC Clin Electrophysiol. 2020;6(11):1367-1376. https://doi.org/10.1016/j.jacep.2020.06.020
  7. Naito M, David D, Michelson EL, Schaffenburg M, Dreifus LS. The hemodynamic consequences of cardiac arrhythmias: Evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model. Am Heart J. 1983;106(2):284-291. https://doi.org/10.1016/0002-8703(83)90194-1
  8. Daoud EG, Weiss R, Bahu M, Knight BP, Bogun F, Goyal R, et al. Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol. 1996;78(12):1433-1436. https://doi.org/10.1016/s0002-9149(97)89297-1
  9. Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156. https://doi.org/10.1161/CIR.0000000000001193
  10. Lim KT, Davis MJ, Powell A, Arnolda L, Moulden K, Bulsara M, et al. Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial. Europace. 2007;9(7):498-505. https://doi.org/10.1093/europace/eum091
  11. Brignole M, Pentimalli F, Palmisano P, Landolina M, Quartieri F, Occhetta E, et al.; APAF-CRT Trial Investigators. AV junction ablation and cardiac resynchronization for patients with permanent atrial fibrillation and narrow QRS: the APAF-CRT mortality trial. Eur Heart J. 2021;42(46):4731-4739. https://doi.org/10.1093/eurheartj/ehab569
  12. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, Direct His-Bundle Pacing: A Novel Approach to Cardiac Pacing in Patients With Normal His-Purkinje Activation. Circulation. 2000;101(8):869-877. https://doi.org/10.1161/01.cir.101.8.869
  13. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. Can J Cardiol. 2017;33(12):1736.e1-1736.e3. https://doi.org/10.1016/j.cjca.2017.09.013
  14. Keene D, Anselme F, Burri H, Pérez ÓC, Čurila K, Derndorfer M, et al. Conduction system pacing, a European survey: insights from clinical practice. Europace. 2023 May 19;25(5):euad019. https://doi.org/10.1093/europace/euad019
  15. Kircanski B, Boveda S, Prinzen F, Sorgente A, Anic A, Conte G, et al. Conduction system pacing in everyday clinical practice: EHRA physician survey. Europace. 2023;25(2):682-687. https://doi.org/10.1093/europace/euac201
  16. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction. J Am Heart Assoc. 2017 Apr 1;6(4):e005309. https://doi.org/10.1161/JAHA.116.005309
  17. Vijayaraman P, Subzposh FA, Naperkowski A. Atrioventricular node ablation and His bundle pacing. Europace. 2017;19(suppl_4):iv10-iv16. https://doi.org/10.1093/europace/eux263
  18. Su L, Cai M, Wu S, Wang S, Xu T, Vijayaraman P, et al. Long-term performance and risk factors analysis after permanent His-bundle pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure. Europace. 2020;22(Suppl_2):ii19-ii26. https://doi.org/10.1093/europace/euaa306
  19. Pillai A, Kolominsky J, Koneru JN, Kron J, Shepard RK, Kalahasty G, et al. Atrioventricular junction ablation in patients with conduction system pacing leads: A comparison of His-bundle vs left bundle branch area pacing leads. Heart Rhythm. 2022;19(7):1116-1123. https://doi.org/10.1016/j.hrthm.2022.03.1222
  20. Liu Z, Liu X. Feasibility and Safety Study of Concomitant Left Bundle Branch Area Pacing and Atrioventricular Node Ablation with Same-Day Hospital Dismissal. J Clin Med. 2023 Nov 9;12(22):7002. https://doi.org/10.3390/jcm12227002
  21. Rijks JHJ, Lankveld T, Manusama R, Broers B, Stipdonk AMWV, Chaldoupi SM, et al. Left Bundle Branch Area Pacing and Atrioventricular Node Ablation in a Single-Procedure Approach for Elderly Patients with Symptomatic Atrial Fibrillation. J Clin Med. 2023 Jun 13;12(12):4028. https://doi.org/10.3390/jcm12124028
  22. Ponnusamy SS, Basil W, Vijayaraman P. Electrophysiological characteristics of septal perforation during left bundle branch pacing. Heart Rhythm. 2022;19(5):728-734. https://doi.org/10.1016/j.hrthm.2022.01.018
  23. Ravi V, Larsen T, Ooms S, Trohman R, Sharma PS. Late-onset interventricular septal perforation from left bundle branch pacing. HeartRhythm Case Rep. 2020;6(9):627-631. https://doi.org/10.1016/j.hrcr.2020.06.008
  24. Li Q, Dai W, Fang D, Ma W, Lin C, Lu C, et al. Occurrence of ventricular septal perforation in patients with permanent left bundle branch pacing followed up using echocardiographic and computed tomography images. Ann Noninvasive Electrocardiol. 2022 Nov;27(6):e13002. https://doi.org/10.1111/anec.13002
  25. Perepeka EO, Kravchuk BB, Paratsii OM, Hrubyak LM, Leonchuk VL, Sychyk MM. [Transventricular Left Bundle Branch Pacing]. Ukrainian Journal of Cardiovascular Surgery. 2022;30(1):89-93. Ukrainian. https://doi.org/10.30702/ujcvs/22.30(01)/PK016-8993
  26. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al.; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-3520. https://doi.org/10.1093/eurheartj/ehab364
Published
2024-03-27
How to Cite
Perepeka, E. O., & Sikhnevych, R. A. (2024). Safety of One-Stage Atrioventricular Junction Ablation after Pacemaker Implantation for Left Bundle Branch Pacing. Ukrainian Journal of Cardiovascular Surgery, 32(1), 58-63. https://doi.org/10.30702/ujcvs/24.32(01)/PS014-5863
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 32 No 1 2024
Section
HEART RHYTHM DISORDER

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