Safety of His-bundle ablation after pacemaker implantation in patients with persistent or permanent atrial fibrillation.

Abstract

Background: His-bundle ablation after pacemaker implantation is an effective means of rate control in patients with refractory atrial fibrillation (AF). Pacemaker insertion may be complicated by lead dislodgement, and accordingly, His-bundle ablation is commonly postponed to 4-8 weeks after pacemaker implantation. Theoretically, His-bundle ablation itself could also lead to atrial or ventricular lead dislodgement. The precise rate of lead dislodgement in this context is unknown.

Objective: To determine atrial or ventricular lead dislodgements in patients with pacemaker implantation and His-bundle ablation.

Methods: Consecutive patients with AF who received His-bundle ablation between 01/2017 and 12/2022 were retrospectively studied. Two groups were defined. Group 1 had de-novo pacemaker implantation and subsequent His-bundle ablation (at 4-8 weeks after implantation). A second group of patients underwent His-bundle ablation > 8 weeks after pacemakers (group 2) had been previously implanted for other indications. Pacemaker lead dislodgments were assessed as the primary endpoint prior to or immediately after His-bundle ablation and compared between the two groups.

Results: Data from 177 patients were collected. Of these, 110 underwent implantation 4-8 weeks prior to ablation (group 1) and 67 were in group 2. Baseline patient and procedure characteristics were similar. Regarding the primary endpoint, no lead dislodgment was observed in either group. Any lead dislodgments observed occurred within 24 h of pacemaker implantation and were unrelated to His-bundle ablation.

Conclusion: In patients with refractory persistent or permanent AF, His-bundle ablation is safe and no lead dislodgements were detected related to the ablation.