The role of conduction system pacing in patients with atrial fibrillation

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Marina Strocchi¹  Christopher A. Rinaldi²  Nadeev Wijesuriya²  Vishal Mehta²  Jonathan M. Behar²  Felicity De Vere²  Steven A. Niederer³ 

[1] School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom;Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom;School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom;Research and Innovation Cluster, Alan Turing Institute, London, United Kingdom;

关键词: left bundle area pacing;    his bundle pacing;    atrial fibrillation;    cardiac resynchonization therapy;    heart failiure;    AV nodal ablation;   

DOI  :  10.3389/fcvm.2023.1187754

 received in 2023-03-16, accepted in 2023-04-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

Conduction system pacing (CSP) has emerged as a promising novel delivery method for Cardiac Resynchronisation Therapy (CRT), providing an alternative to conventional biventricular epicardial (BiV) pacing in indicated patients. Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.

【 授权许可】

Unknown   
© 2023 Wijesuriya, Mehta, De Vere, Strocchi, Behar, Niederer and Rinaldi.