Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia. Incidence and prevalence are constantly increasing owing to demographics of an aging population. If rhythm control is failing, His-bundle ablation after pacemaker implantation is an effective means of rate control in patients with refractory atrial fibrillation. Nevertheless, there are serious concerns about creating a permanent atrioventricular (AV) block and the associated lifelong commitment to the use of a pacemaker. Pacemaker insertion may be complicated by right ventricular (RV) lead dislodgement and accordingly His-bundle ablation is commonly postponed to 4-8 weeks after pacemaker implantation. Theoretically, His-bundle ablation itself could also lead to lead dislodgement. The precise rate of RV lead dislodgement in this context is unknown.

Purpose

To determine RV lead dislodgements in patients with pacemaker implantation and His-bundle ablation.

Methods

We retrospectively studied consecutive patients with AF who received His-bundle ablation between 01/2017 and 12/2022 in St. Josefs-Hospital Wiesbaden, Germany. Two groups were defined. Group 1 had de-novo pacemaker implantation and subsequent His-bundle ablation (at 4-8 weeks after implantation). A second group of patients had His-bundle ablation after >8 weeks implanted pacemakers (group 2). RV lead dislodgments were assessed as primary endpoint acutely after ablation and per follow-up until first pacemaker clinic visit after ablation and compared between the two groups.

Results

Data from 177 patients were collected. Of these 110 had implant 4-8 weeks prior to ablation (group 1) and 67 > 8 weeks before ablation (group 2). Baseline patient and procedure characteristics were similar. Regarding to the primary endpoint we did not detect any RV lead dislodgements in both groups. Two right atrial lead dislodgments occurred in group 1. Both happend within 48 hours after implantation and were not related to ablation. Leads could be reimplanted without complications. After CRT implantation, three coronary sinus (CS) lead revisions were required due to inadequate LV pacing (n=2) and phrenic nerve capture (n=1). This was similarly not related to His-bundle ablation.

Conclusion

In patients with refractory AF, His-bundle ablation is safe and no RV lead dislodgements were detected after His-bundle ablation.