Predictors of therapeutic response to left bundle branch area pacing and atrioventricular node ablation in patients with atrial fibrillation and heart failure
L S Shen, H L Li, K Tang, D D ZhaoAbstract
Background
Left bundle branch area pacing (LBBAP) with atrioventricular node (AVN) ablation has emerged as a promising therapy for patients with atrial fibrillation (AF) and symptomatic heart failure (HF). However, it remains unclear which patients are likely responders and which may derive limited benefit.
Objective
This study aimed to identify predictors of unfavorable therapeutic outcomes following this ‘ablate and pace’ therapy.
Methods
Consecutive patients with successful LBBAP and AVN ablation were included. Baseline characteristics and long-term outcomes were assessed. Multivariable cox regression and reclassification analysis were used to evaluate the predictors of heart failure hospitalization (HFH).
Results
Ninety-eight patients (age 73.1 ± 8.9 years; ventricular rate 93.6 ± 18.7 bpm; 41.8% male) were enrolled. During 43.9 ± 19.4 months of follow-up, 19 (19.4%) patients experienced HFH. The eGFR ≤ 60 mL/min/1.73m2 (HR: 7.9, 95% CI: 2.7-22.9, P < 0.001), LAD ≥ 50 mm (HR: 4.8, 95% CI: 1.9-12.5, P = 0.001), and male sex (HR: 3.9, 95% CI: 1.5-10.3, P = 0.006) were the strongest risk markers. All patients with 3 risk factors experienced HFH within 2 years, whereas none of 25 patients without any risk factors experienced the endpoint during 113 patient years of follow-up.
Conclusions
Response to 'ablate and pace' therapy in patients with AF and HF is variable and can be stratified by risk. The eGFR ≤ 60 mL/min/1.73m2, LAD ≥ 50 mm, and male sex were strong predictors of poor therapeutic outcomes. Patients without any of these risk factors had minimal HFH risk, whereas ≥ 2 risk factors increased the risk dramatically. This may help to make decisions on selection of appropriate individuals for this combined treatment.Prediction models of efficacy