The Outcomes of Physiological Ventricular Rhythm Resetting with AV Node Ablation and Left Bundle Branch Pacing in Patients with AF-Induced Cardiomyopathy: A Prospective Cohort Study.

Abstract

The mechanism of AF-induced cardiomyopathy (AF-CM) is still unclear. Expect for heart rate, atrial contraction lost and ventricular rhythm irregularity are believed as possible contributors to AF-CM. This study aimed to investigate ventricular rhythm irregularity effects on AF-CM. The AF-CM patients underwent the physiological ventricular rhythm resetting (PVRR) with atrioventricular node ablation combined with left bundle branch pacing or pharmacological therapy. To avoid heart rate effects, the heart rate (HR) setting according to preoperative Holter averages heart rate for each patient in the PVRR group. The primary endpoint was the echocardiographic response rate, defined as an absolute increase of left ventricular ejection fraction (LVEF) > 5%. Secondary endpoints included heart failure (HF) rehospitalization and worsening HF. Finally, 71 patients (mean age 65±11 years, 36 PVRR and 35 no-PVRR group) were enrolled this study. Compared with no-PVRR group, the PVRR without changed pre-and post-procedure HR significantly enhance echocardiographic response rate (86.1% vs. 31.4%, P<0.001), improve LVEF (12.0±6.6% vs. 4.0±8.1%, P<0.001), and shorten left ventricular end-diastolic diameter, and left ventricular end-systolic diameter (-4.6±4.1mm vs. -1.7±5.5mm, P<0.05; -6.8±3.8mm vs. -2.4±6.3mm, P<0.01, respectively) in 13.1±6.6 months follow-up. Furthermore, HF rehospitalization and worsening HF rates were significantly lower in the PVRR group (5.6% vs. 31.4%, P< 0.01). In conclusion, the ventricular rhythm irregularity is an important reversible contributor for AF-CM. The PVRR significantly enhances cardiac function, lowers HF rehospitalization and worsening HF rates. The PVRR could become a promising therapeutic strategy for AF-CM patients.