His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial

doi:10.1016/j.hrthm.2022.07.009

科研成果详情

题名	His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial
作者	Huang, Weijian1,2; Wang, Songjie 1,2; Su, Lan1,2; Fu, Guosheng 3; Su, Yangang 4; Chen, Keping 5; Zou, Jiangang 6; Han, Hongwei 7; Wu, Shengjie1,2; Sheng, Xia 3; Chen, Xueying 4; Fan, Xiaohan 5; Xu, Lei1,2; Zhou, Xiaohong 8; Mao, Guangyun9; Ellenbogen, Kenneth A.10; Whinnett, Zachary I.11
发表日期	2022-12
发表期刊	HEART RHYTHM 影响因子和分区
语种	英语
原始文献类型	Article ; Randomized Controlled Trial ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
关键词	Atrial fibrillation Atrioventricular nodal ablation Cardiac resynchronization therapy Heart failure His-bundle pacing
其他关键词	CARDIAC-RESYNCHRONIZATION THERAPY ; HEART-FAILURE ; NARROW QRS ; DYSSYNCHRONY ; MORTALITY
摘要	BACKGROUND Atrioventricular nodal ablation (AVNA) combined with biventricular pacing (BVP) improves outcomes in patients with persistent atrial fibrillation (AF), adequate rate control, and reduced left ventricular ejection fraction (LVEF). His-bundle pacing (HBP) delivers physiological ventricular activation and is a promising alternative to BVP. OBJECTIVE The purpose of this trial was to compare HBP with BVP following AVNA. METHODS In this multicenter, prospective, randomized crossover trial, we recruited patients with persistent AF and reduced LVEF (<= 40%). All patients underwent AVNA and received both HBP and BVP. Patients were randomized to either HBP or BVP for 9 months (phase 1), then were switched to the alternative pacing modality for the next 9 months (phase 2). The primary endpoint was change in LVEF. RESULTS Fifty patients (age 64.3 +/- 10.3 years; ventricular rate 93.1 +/- 19.9 bpm; 72% male) were enrolled. Thirty-eight patients completed the 2 phases and were included in the crossover analysis. A significant improvement in LVEF was observed with HBP compared to BVP (phase 1: Delta LVEFHBP 21.3% and Delta LVEFBVP 16.7%; phase 2: Delta LVEFHBP 3.5% and Delta LVEFBVP -2.4%; P-generalized additive model - 0.015). Significant improvements in left ventricular end-diastolic diameter, New York Heart Association functional class, and B-type natriuretic peptide level were observed with both pacing modalities compared with baseline, whereas no significant differences were observed between HBP and BVP. CONCLUSION HBP delivers a modest but significant improvement in LVEF in patients with persistent AF, impaired ventricular function, and narrow QRS duration post-AVNA compared with BVP. Larger long-term trials are required to confirm the additional improvements in function with HBP.
资助项目	Key Research and Development Program of Zhejiang, China [2019C03012]
出版者	ELSEVIER SCIENCE INC
出版地	NEW YORK
ISSN	1547-5271
EISSN	1556-3871
卷号	19 期号:12 页码:1948-1955
DOI	10.1016/j.hrthm.2022.07.009
页数	8
WOS类目	Cardiac & Cardiovascular Systems
WOS研究方向	Cardiovascular System & Cardiology
WOS记录号	WOS:000904873400002
收录类别	SCIE ; SCOPUS ; PUBMED
URL	查看原文
PubMed ID	35843465
SCOPUSEID	2-s2.0-85137059983
ESI热点论文	2023-03
通讯作者地址	[Huang, Weijian]Department of Cardiology,The First Affiliated Hospital of Wenzhou Medical University,Nanbaixiang,Wenzhou 325000,P.R.,China
Scopus学科分类	Cardiology and Cardiovascular Medicine;Physiology (medical)
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/172354
专题	附属第一医院仁济学院_环境与公共卫生学部
通讯作者	Huang, Weijian
作者单位	1.Department of Cardiology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,China; 2.The Key Lab of Cardiovascular Disease,Science and Technology of Wenzhou,Wenzhou,China; 3.Department of Cardiology,Sir Run Run Shaw Hospital affiliated to Medical College of Zhejiang University,Hangzhou,China; 4.Department of Cardiology,Zhongshan Hospital of Fudan University,Shanghai,China; 5.State Key Laboratory of Cardiovascular Disease,Arrhythmia Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing,China; 6.Department of Cardiology,Jiangsu Province Hospital,Nanjing,China; 7.Department of Cardiovascular Medicine,Wuhan Asia Heart Hospital,Wuhan,China; 8.Cardiac Rhythm Management,Medtronic PLC,Mounds View,United States; 9.School of Environmental Science & Public Health,Wenzhou Medical University,Wenzhou,China; 10.Department of Cardiology,Virginia Commonwealth School of Medicine,Richmond; 11.National Heart and Lung Institute,Imperial College London,London,United Kingdom
第一作者单位	附属第一医院; 第一临床医学院（信息与工程学院）、附属第一医院
通讯作者单位	附属第一医院; 第一临床医学院（信息与工程学院）、附属第一医院
第一作者的第一单位	附属第一医院
推荐引用方式 GB/T 7714	Huang, Weijian,Wang, Songjie,Su, Lan,et al. His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial[J]. HEART RHYTHM,2022,19(12):1948-1955.
APA	Huang, Weijian., Wang, Songjie., Su, Lan., Fu, Guosheng., Su, Yangang., ... & Whinnett, Zachary I.. (2022). His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial. HEART RHYTHM, 19(12), 1948-1955.
MLA	Huang, Weijian,et al."His-bundle pacing vs biventricular pacing following atrioventricular nodal ablation in patients with atrial fibrillation and reduced ejection fraction: A multicenter, randomized, crossover study-The ALTERNATIVE-AF trial".HEART RHYTHM 19.12(2022):1948-1955.