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New-onset atrial high-rate episodes between his bundle pacing and conventional right ventricular septum pacing in patients with atrioventricular conduction disturbance

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Abstract

Background

The effect of His bundle pacing (HBP) on the incidence of new-onset atrial fibrillation (AF) after pacemaker implantation (PMI) for atrioventricular conduction disturbance (AVCD) remains unknown. We compared the incidence of new-onset atrial high-rate episode (AHRE) in conventional right ventricular (RV) septum pacing (RVSP) and His bundle pacing (HBP) after PMI for AVCD.

Methods

One hundred and four consecutive patients who underwent dual chamber PMI for AVCD in our hospital were screened. Thirty-five patients with mitral or aortic valve disease, history of open-heart surgery, prior AF, subclinical AF, cumulative ventricular pacing percentage < 90%, and RV lead revision were excluded, and 69 patients were effectively enrolled in this study. The primary endpoint was new-onset AHRE within the follow-up period. New-onset AHRE was defined as an atrial high-rate episode that occurred 3 months after PMI and lasted for > 6 min at an atrial heart rate > 190 bpm. RV leads were placed in the His bundle region and RV septum region in 22 and 47 patients, respectively. The mean follow-up period was 539 ± 218 days. The follow-up period was 2 years after PMI or until the new-onset AHRE occurred.

Results

The incidence of new-onset AHRE was lower in the HBP group than in the RVSP group (11% vs. 43%, p = 0.01). Multivariate analysis in the Cox regression hazard model showed that HBP had a significantly lower risk of new-onset AHRE compared with RVSP (HR = 0.21; 95% confidence interval 0.04–0.78, p = 0.02).

Conclusion

The incidence of new-onset AHRE was significantly less in HBP compared to RVSP during the 2-year follow-up period after pacemaker implantation in AVCD patients with RV pacing dependence.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all the members of the Department of Cardiology, Tokyo Metropolitan Hiroo Hospital.

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu Shibuya-Ku, Tokyo, 150-0013, Japan

    Masao Takahashi, Hirofumi Kujiraoka, Tomoyuki Arai, Takashi Kimura, Rintaro Hojo & Seiji Fukamizu

Authors
  1. Masao Takahashi
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  2. Hirofumi Kujiraoka
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  3. Tomoyuki Arai
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  4. Takashi Kimura
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  5. Rintaro Hojo
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  6. Seiji Fukamizu
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Contributions

M.T. designed the study, the main conceptual ideas, and the proof outline. M.T., H.K., T.A., and T.K. collected the data. M.T., R.H., and S.F. aided in interpreting the results and worked on the manuscript. S.F. supervised the project. M.T. wrote the manuscript with support from R.H. and S.F. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Masao Takahashi.

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Ethics approval statement

The Institutional Ethics Committee of our hospital approved this retrospective cohort study.

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Written informed consent was obtained from all individual participants included in the study.

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The authors have no competing interests to declare that are relevant to the content of this article.

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Takahashi, M., Kujiraoka, H., Arai, T. et al. New-onset atrial high-rate episodes between his bundle pacing and conventional right ventricular septum pacing in patients with atrioventricular conduction disturbance. J Interv Card Electrophysiol 67, 471–477 (2024). https://doi.org/10.1007/s10840-023-01605-w

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  • DOI: https://doi.org/10.1007/s10840-023-01605-w

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