PO-02-156 THE RISE OF LEFT BUNDLE BRANCH AREA "PACE AND ABLATE"; AV NODAL ABLATION OUTCOMES, WHERE ARE WE NOW?

Abstract

A “pace and ablate” strategy should be considered for those with symptomatic atrial fibrillation (AF) when other therapies have been unsuccessful. Pacemaker induced cardiomyopathy due to RV pacing is a recognised consequence. Left bundle branch area pacing (LBBAP) mitigates this cardiomyopathy compared to RV pacing. As LBBAP becomes more widespread, we expect greater uptake of AV nodal (AVN) ablation “pace and ablate” strategy in those with symptomatic AF. We undertook a multicentre retrospective registry analysis of our patients who underwent AV nodal ablation to assess current real-world procedure data and patient outcomes. We conducted a retrospective multi-centre registry review of outcome data for our patients who underwent AVN ablation over the period of April 2019 until March 2020. We included patients >18 years old who underwent AVN ablation for the purposes of a “pace and ablate” strategy for symptomatic AF despite other strategies. N=52 patients met inclusion criteria. Median age was 74 years (IQR 67, 82), with 28 males. 18 patients had paroxysmal AF, 12 persistent AF and 22 longstanding persistent AF. 10 patients had other documented arrhythmias including arial flutter (4), ventricular tachycardia (3), SVT (2) or atrial tachycardia (1). 9 patients (17%) had previous cardiac surgery including CABG or valve replacements. All patients had successful AVN ablation with durable lesion creation. Radiofrequency was utilised in all patients, with a median application time of 2.67 minutes (IQR: 2, 5.4). Median skin-to-skin procedure time was found to be 55.5 minutes (IQR: 43.75, 73), with a fluoroscopy median time of 3.5 minutes (IQR: 1.55, 6.48). Median radiation dose was 11 mGy (IQR: 4, 16.27). 11 patients had biventricular pacing devices in situ with 41 patients implanted with a conventional pacemaker. There were no acute complications of the procedure. One patient died due to renal failure and one patient had a stroke within 3 months of the procedure but neither of these were directly linked. Our analysis found durable lesion creation with 100% ablation success in our cohort with a median fluoroscopy time of 3.5 minutes and dose of 11 mGy. There were no acute or subacute complications related to the procedure, as far out as 3 months. 11 (21%) patients had biventricular devices with the rest having conventional pacemakers. No patients had conduction system leads implanted, which is likely to change in the coming years.