Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS

Background: His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. We compared short-term results of both pacing approaches in symptomatic atrial fibrillation (AF) patients with moderately reduced left ventricular (LV) ejection fraction (EF >= 35% and <50%) and narrow QRS (<= 120 ms) who underwent atrioventricular node ablation (AVNA). Methods: Thirty consecutive AF patients who received BiV pacing or HBP in conjunction with AVNA between May 2015 and January 2020 were retrospectively assessed. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed. Results: Twenty-four patients (age 68.8 +/- 6.5 years, 50% female, EF 39.6 +/- 4%, QRS 95 +/- 10 ms) met the inclusion criteria, 12 received BiV pacing and 12 HBP. Both groups had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of post-implant QRS duration, implantation fluoroscopy times, reduction of indexed LV volumes (EDVi 63.8 (49.6-81) mL/m(2) vs. 79.9 (66-100) mL/m(2), p = 0.055; ESVi 32.7 (25.6-42.6) mL/m(2) vs. 46.4 (42.9-68.1) mL/m(2), p = 0.009) and increase in LVEF (46 (41-55) % vs. 38 (35-42) %, p = 0.005). However, the improvement of the NYHA class was similar in both groups. Conclusions: In symptomatic AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both 'ablate and pace' strategies.