AP-452681-1 NIRVANA: LEFT BUNDLE AREA PACING AND ATRIOVENTRICULAR NODAL ABLATION HAS AN EXCELLENT PROCEDURAL SAFETY PROFILE

Abstract

Conduction system pacing in the form of Left Bundle Area Pacing (LBAP) has become an accepted form of pacing in patients who will have a high degree of pacing from the right ventricle or/and have a history of heart failure. In patients with persistent or poorly controlled AF, that are not ablation candidates or fail medical therapy, atrioventricular nodal (AVN) ablation with permanent pacemaker is an acceptable alternative. LBAP is a more complex procedure than standard right ventricular pacing. Relatively little data exists, on the safety of using LBAP instead of standard right ventricular pacing (RVP) in patients undergoing AVN ablation. To describe the complication profile of left bundle area pacing in comparison to right ventricular with atrioventricular nodal ablation over a six-month follow up at a large volume center. We identified all patients that underwent LBAP or right ventricular pacing with AVN ablation over the last 2 years and had 6 months of follow-up. Left bundle capture was defined by several accepted criteria (septal 3830 leads on or near the left bundle, pacing left ventricular activation timing (pLVAT) ≤80 msec in V5/V6, left bundle potential, appropriate narrowing of the QRS complex). Only patients with AVN ablation who underwent pacemaker implant at the same time (within 24 hours) were included. Any patients with advanced heart failure with severely reduced ejection fraction that failed left ventricular lead placement was excluded from analysis. 156 patients met the inclusion criteria. As illustrated in Table I, 115 patients were in the LBAP group and 41 where in the right ventricular pacing group. Baseline characteristics were not statistically different. The population was predominantly female, had a preserved ejection fraction (EF) and were patients with paroxysmal atrial fibrillation (38.3% LBAP vs 43.9%). Total complications were not different between the groups (5.2% LBAP vs 0% RVP, p=0.34). Absolute complications in any category in any group were low, Figure 1. All complications were seen in the first 30 days post implant, except for a TIA in the LBAP group, seen at 163 days post procedure. Left bundle area pacing as compared to standard right ventricular pacing with concomitant atrioventricular nodal ablation in patients with atrial fibrillation have a similar safety profile during a six month follow-up.