Atrioventricular Node Ablation Combined with Permanent His-Purkinje Conduction System Pacing in Patients with Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis

Introduction: As there are no relevant systematic reviews that evaluate the efficacy of His-Purkinje conduction system pacing (HPCSP) in patients with atrial fibrillation (AF) with heart failure who have undergone atrioventricular node ablation (AVNA), we performed a meta-analysis to evaluate the efficacy of HPCSP after AVNA in such cases. Methods We searched the PubMed, the Cochrane Library, and Embase databases for studies on the impact of AVNA combined with HPCSP on patients with AF with heart failure published between 2000 and 2021. Review Manager 5.3 software was used for the meta-analysis. The clinical results evaluated included changes in left ventricular (LV) function, QRS duration, pacing threshold, and medication after surgery. Results The pooled results showed a significant difference in LV ejection fraction, LV end-diastolic dimension, New York Heart Association classification, and brain natriuretic peptide when baseline and follow-up values were compared (P < 0.01). The number of patients taking diuretics, β-blockers, and digoxin at baseline was significantly reduced at follow-up (P < 0.01). However, the number of patients taking angiotensin-converting enzyme inhibitors did not change significantly (P = 0.89). Regarding QRS duration, there was no significant difference between AVNA and HPCSP compared with before implementation (P = 0.05); however, an increasing trend was observed in the pacing threshold at follow-up compared with baseline (P < 0.01). Conclusion AVNA combined with HPCSP could significantly improve LV function at follow-up and reduce the administration of diuretics, β-blockers, and digoxin for patients with AF with heart failure.