The role of conduction system pacing in patients with atrial fibrillation

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Abstract

Conduction system pacing (CSP) has emerged as a promising novel delivery method for Cardiac Resynchronisation Therapy (CRT), providing an alternative to conventional biventricular epicardial (BiV) pacing in indicated patients. Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.

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Most cited references 51

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Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge

Giuseppe Lippi, Fabian Sanchis-Gomar, Gianfranco Cervellin (2020)

Atrial fibrillation is the most frequent cardiac arrhythmia. It has been estimated that 6–12 million people worldwide will suffer this condition in the US by 2050 and 17.9 million people in Europe by 2060. Atrial fibrillation is a major risk factor for ischemic stroke and provokes important economic burden along with significant morbidity and mortality. We provide here comprehensive and updated statistics on worldwide epidemiology of atrial fibrillation. An electronic search was conducted for atrial fibrillation. The epidemiologic information was retrieved from the Global Health Data Exchange database, which is regarded as one of the most comprehensive worldwide catalogs of surveys, censuses, vital statistics, and other health-related data. A total of 3.046 million new cases of atrial fibrillation worldwide were registered in the database during 2017. The estimated incidence rate for 2017 (403/millions inhabitants) was 31% higher than the corresponding incidence in 1997. The worldwide prevalence of atrial fibrillation is 37,574 million cases (0.51% of worldwide population), increased also by 33% during the last 20 years. The highest burden is seen in countries with high socio-demographic index, though the largest recent increased occurred in middle socio-demographic index countries. Future projections suggest that absolute atrial fibrillation burden may increase by >60% in 2050. Our analyses suggest that atrial fibrillation incidence and prevalence have increased over the last 20 years and will continue to increase over the next 30 years, especially in countries with middle socio-demographic index, becoming one of the largest epidemics and public health challenges.

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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

Michael Glikson, Jens Nielsen, Mads Brix Kronborg … (2021)

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A beginner's guide to permanent left bundle branch pacing

Weijian Huang, Xueying Chen, Lan Su … (2019)

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Author and article information

Contributors

Nadeev Wijesuriya: URI : https://loop.frontiersin.org/people/1472845/overview

Vishal Mehta: URI : https://loop.frontiersin.org/people/1365025/overview

Felicity De Vere: URI : https://loop.frontiersin.org/people/2051890/overview

Marina Strocchi: URI : https://loop.frontiersin.org/people/1210872/overview

Jonathan M. Behar: URI : https://loop.frontiersin.org/people/1926182/overview

Steven A. Niederer: URI : https://loop.frontiersin.org/people/27639/overview

Christopher A. Rinaldi: URI : https://loop.frontiersin.org/people/1325164/overview

Journal

Journal ID (nlm-ta): Front Cardiovasc Med

Journal ID (iso-abbrev): Front Cardiovasc Med

Journal ID (publisher-id): Front. Cardiovasc. Med.

Title: Frontiers in Cardiovascular Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2297-055X

Publication date (Electronic): 25 May 2023

Publication date Collection: 2023

Volume: 10

Electronic Location Identifier: 1187754

Affiliations

[ ¹ ]School of Biomedical Engineering and Imaging Sciences, King’s College London , London, United Kingdom

[ ² ]Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust , London, United Kingdom

[ ³ ]Research and Innovation Cluster, Alan Turing Institute , London, United Kingdom

Author notes

Edited by: Justin Luermans, Maastricht University Medical Centre, Netherlands

Reviewed by: Karol Curila, Charles University, Czechia Teresa Strisciuglio, University of Naples Federico II, Italy

[* ] Correspondence: Nadeev Wijesuriya nadeev.wijesuriya@ 123456kcl.ac.uk

Article

DOI: 10.3389/fcvm.2023.1187754

PMC ID: 10248047

PubMed ID: 37304966

SO-VID: ac3cc2cc-a2de-4b08-8a29-25b4362e300a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 16 March 2023

Date accepted : 24 April 2023

Page count

Figures: 2, Tables: 0, Equations: 0, References: 53, Pages: 0, Words: 0

Funding

The authors are supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z). NW receives fellowship funding from the British Heart Foundation (FS/CRTF/22/24362). VM has received fellowship funding from Abbott. SAN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812, PG/13/37/30280, SP/18/6/33805, RG/20/4/34803), US National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055) and Kings Health Partners London National Institute for Health Research (NIHR) Biomedical Research Centre. JMB receives research funding and/or consultation fees from Abbott, Siemens Healthcare, EBR Systems, Biosense Webster outside of the submitted work. CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work.

Custom metadata

section-at-acceptance Cardiac Rhythmology

Keywords: left bundle area pacing,his bundle pacing,atrial fibrillation,cardiac resynchonization therapy,heart failiure,av nodal ablation

Data availability:

Keywords: left bundle area pacing, his bundle pacing, atrial fibrillation, cardiac resynchonization therapy, heart failiure, av nodal ablation

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