Mid-term comparison of new-onset AHRE between His bundle and left bundle branch area pacing in patients with AV block

Background

Atrial high-rate episodes (AHRE) detected by cardiac implanted electronic devices are known markers for adverse cardiac events. Previous studies have shown that the incidence of new-onset AHREs in patients with right ventricular pacing reaches 50%. At the same time, His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) were associated with significantly fewer AHRE. This study aimed to compare the incidence of new-onset AHRE between HBP and LBBAP in patients with atrioventricular block and no history of atrial fibrillation.

Methods

One hundred and forty-two patients, fifty-nine with HBP and eighty-three with LBBAP for advanced atrioventricular block, were prospectively followed for new-onset AHRE.

Results

The mean follow-up period was 624 ± 148.6 days for the HBP patients and 663.4 ± 157.4 days for the LBBAP patients. New-onset AHRE was encountered in 8 of 59 patients (13.5%) with HBP and 14 of 83 (16.8%) with LBBAP (hazard ratio—0.91, log rank p = .84). In the multivariate Cox regression model, HBP and LBBAP had similar predictive values, while only age and diabetes mellitus were significantly associated with new-onset AHRE occurrence.

Conclusion

HBP and LBBAP were associated with a similar incidence of device-detected new-onset AHRE during a medium-term follow-up period in patients with atrioventricular block and no history of atrial fibrillation.