The role of conduction system pacing in patients with atrial fibrillation

TY - JOUR

T1 - The role of conduction system pacing in patients with atrial fibrillation

AU - Wijesuriya, Nadeev

AU - Mehta, Vishal

AU - De Vere, Felicity

AU - Strocchi, Marina

AU - Behar, Jonathan M.

AU - Niederer, Steven A.

AU - Rinaldi, Christopher A.

N1 - Publisher Copyright: 2023 Wijesuriya, Mehta, De Vere, Strocchi, Behar, Niederer and Rinaldi.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - atrial fibrillation

KW - AV nodal ablation

KW - cardiac resynchonization therapy

KW - heart failiure

KW - his bundle pacing

KW - left bundle area pacing

UR - http://www.scopus.com/inward/record.url?scp=85161424319&partnerID=8YFLogxK

U2 - 10.3389/fcvm.2023.1187754

DO - 10.3389/fcvm.2023.1187754

M3 - Review article

AN - SCOPUS:85161424319

SN - 2297-055X

VL - 10

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 1187754

ER -