[Abstract]
Atrioventricular node ablation (AVNA) combined with His bundle pacing
(HBP) are feasible, safe, and effective in patients with refractory
atrial fibrillation (AF), however, the pacing parameters of sensing and
capture threshold maybe sometimes unsatisfactory. Left bundle branch
pacing (LBBP) provides obvious advantage in patients with conduction
diseases at the distal His bundle for its better sensing, a lower and
more stable capture threshold. Among hypertrophic cardiomyopathy (HCM)
patients, AF is a common sustained arrhythmia, primarily caused by left
atrial dilatation and remodeling. Few is known about the feasibility of
electrophysiological performance, safety and clinical effectiveness of
atrioventricular junction ablation (AVJA) combined with LBBP in patient
with refractory AF and HCM. Here,
we report a case of a 56-year-old woman suffering from refractory AF and
HCM, however HBP was failed for its unsatisfactory sensing, a high and
unstable capture threshold for her, therefore, ablation and LBBB were
accepted by her to achieve better rate control. Improvement in symptoms,
quality of life, and exercise capacity has been observed during the
1.5-year follow-up. To our knowledge, our case originally confirmed that
the combination of AVJA and LBBP, without the defect of AVNA combined
with HBP, is a better strategy with feasibility and safety for
refractory AF patients with comorbidity of HCM, additionally, it may
make LBBP more applicable and valuable among patients suffering from HCM
meanwhile pace maker treatments are essential.