부산대학교 도서관

Purpose: Ablate and pace provide optimal rate control in patient with symtpomatic atrial fibrillation. Main drawback of this strategy is life-long nonphysiologic ventricular activation. An appealing solution is to set up a AV node electric bypass (AVNEB) combining pure His bundle stimulation with compact node ablation. We sought to investigate the feasibility and the long term clinical and technical outcome of this strategyMethods: 12 (67±6 years) patients (pts) with long lasting symptomatic refractory atrial fibrillation were enrolled. Echo, six minute walking distance (6MWD) and quality of life (SF 36) were assessed at enrolment. All patients underwent an attempt of AVNEB; if it failed, a conventional ablate and pace procedure was delivered. In patients undergoing AVNEB a second back up lead was implanted. Follow up was repeated at 3, 6 and 12 months.Results: In 10/12 pts AVNEB was achieved. In this group, we observed a transient loss of His capture during RF application in 5 pts, a late loss of His capture in 2 pts and a recovery of AV conduction in 2 patients. His capture threshold increased over time (2,5 times at 1 year vs baseline). In all 12 patients, we observed a significant improvement of quality of life and 6MWD, while EF increase was not significantConclusions: Although AVNEB is an attractive therapeutic strategy, we observed important technical drawbacks that may limit its clinical routine applicability. The main challenge seems to be the capability of delivering a stable pure His pacing together with an efficacious AV node ablation. According to our experience a first line routine application AVNEB might not be worthwhile. (Table is included in full-text article.)