LAUSR

BACKGROUND Single-center studies showed feasibility of conduction system pacing (CSP) via His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) in atrial fibrillation (AF) patients undergoing atrioventricular junction ablation (AVJA). OBJECTIVE We compared outcomes in patients with HBP and LBBAP leads undergoing AVJA. METHODS Consecutive patients with CSP leads referred for AVJA between 10/2014-05/2021 were included. Pacing lead characteristics, procedural characteristics, complications and long-term outcomes were assessed. RESULTS 105 AVJA procedures (55 HBP, 50 LBBAP) were performed in 98 patients (48 HBP, 50 LBBAP). The acute success rate of the AVJA procedure was 94% vs 100% (p=0.11) in HBP vs LBBAP groups. Seven (14%) redo AVJA procedures were required in the HBP group. The mean procedure time (44±24 vs 34±16 mins, p=0.02) and mean fluoroscopy time (16±18 vs 7±6, p<0.001) were significantly longer in the HBP vs LBBAP group. An acute rise in threshold was noted in 8 (14.5%) cases and 4 (8%) developed exit block following AVJA in HBP patients. Chronic HBP threshold ≥2.5V was seen in 23 (48%) patients and 4 (8%) HBP leads were deactivated. CSP preserved EF in the overall cohort (N=70, 53±10% vs 55±10%, p=0.09) and significantly improved in those with reduced EF<50% at baseline (N=16, 37±7.6% vs 46±13%, p=0.02). CONCLUSION AVJA in presence of a LBBAP lead is associated with a higher success rate and lower acute and chronic lead related complications. CSP with either HBP or LBBAP preserves LV systolic function in patients with refractory AF post AVJA.