Superior approach from the pocket for atrioventricular junction ablation performed at the time of conduction system pacing implantation

Background Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket via axillary or subclavian vein has been proposed as an alternative to the conventional f...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 2023-12, Vol.46 (12), p.1652-1661
Main Authors: Palmisano, Pietro, Parlavecchio, Antonio, Crea, Pasquale, Guido, Alessandro, Accogli, Michele, Coluccia, Giovanni
Format: Article
Language:English
Subjects:
ablate and pace
Ablation
Atrial Fibrillation
Atrioventricular Node - surgery
AV junction ablation
Bundle of His
Cardiac Conduction System Disease
Cardiac Pacing, Artificial - methods
catheter ablation
Catheter Ablation - methods
Conduction
conduction system pacing
Femoral artery
Femur
Heart Conduction System
His bundle pacing
Humans
left bundle branch area pacing
narrow QRS
Prospective Studies
Treatment Outcome
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Summary:Background Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket via axillary or subclavian vein has been proposed as an alternative to the conventional femoral venous access (FA) to perform AVJA. Objective To assess the feasibility and safety of SA for AVJA performed simultaneously with CSP, and to compare this approach with FA. Methods A prospective, observational study, enrolling consecutive patients with symptomatic, refractory AF undergoing simultaneous CSP and AVJA. Results A total of 107 patients were enrolled: in 50, AVJA was primarily attempted with SA, in 69 from FA. AVJA with SA was successful in 38 patients (76.0%), while in 12 patients, a subsequent FA was required. AVJA from FA was successful in 68 patients (98.5%), while in one patient, a left‐sided approach via femoral artery was required. Compared with FA, SA was associated with a significantly longer duration of ablation (238.0 ± 218.2 vs. 161.9 ± 181.9 s; p = .035), a significantly shorter procedure time (28.1 ± 19.8 vs. 19.8 ± 16.8 min; p = .018), an earlier ambulation (2.7 ± 3.2 vs. 19.8 ± 0.1 h; p 
ISSN:0147-8389
1540-8159
DOI:10.1111/pace.14849