His-Purkinje conduction system pacing combined with atrioventricular node ablation improves quality of life in older patients with persistent atrial fibrillation refractory to multiple ablation procedures

BACKGROUND Recurrence of atrial fibrillation(AF)is common in patients with persistent AF even after multiple ablation procedures.His-Purkinje conduction system pacing(HPCSP)combined with atrioventricular node ablation(AVNA)is effective in managing patients with AF and heart failure.This study aimed to determine whether HPCSP combined with AVNA can improve quality of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures,as well as evaluate the feasibility and safety of this therapy.METHODS Older patients(≥65 years)with symptomatic persistent AF refractory to at least two ablation procedures were treated with combined HPCSP and AVNA.The success rates and complications were recorded.Pacing parameters,European Heart Rhythm Association(EHRA)scores,and Atrial Fibrillation Effect on Quality-of-Life(AFEQT)scores obtained perioperatively were compared with those recorded at the 6-month follow-up examination.RESULTS Thirty-one patients were enrolled;of those,only thirty patients were eventually treated with AVNA because one patient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead.The success rates were 100%for HPCSP(22 cases with His bundle pacing,and 9 cases with left bundle branch pacing)and 93.3%(28/30)for AVNA,respectively.By the 6-month follow-up examination,EHRA scores improved significantly(3.00±0.73 vs.2.44±0.63,P=0.014)and AFEQT scores increased markedly(49.6±20.6 vs.70.9±14.0,P=0.001).No severe complications developed.CONCLUSIONS When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures,HPCSP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up.This therapy was proved to be safe and effective in this patient population.

Fifteen-year mortality and prognostic factors in patients with dilated cardiomyopathy:persistent standardized application of drug therapy and strengthened management may bring about encouraging change in an aging society

BACKGROUND There is scarce data on the long-term mortality and associated prognostic factors in patients with dilated car-diomyopathy(DCM).The study aimed to investigate the all-cause mortality up to 15 years(mean 7.9±5.7 years)in such patients,and the independent prognostic factors influencing their long-term mortality.METHODS One hundred and sixty-six consecutive patients with DCM were prospectively enrolled from 2002 to 2003.The mean age of patients was 59.5±10.4 years,and approximately 57%were male.They were followed up by telephone or outpa-tient visit at least every three months until 2019 or all-cause death occurred.Predictors of mortality were identified using mul-tivariate logistic regression analysis.RESULTS During the 15 years of follow-up,five patients were lost to follow-up,and the complete data records of 161 patients were included in the analysis.Patients were treated with angiotensin-converting-enzyme inhibitors(ACEI)or angiotensin-recept-or blocker(ARB),β-blockers,mineralocorticoid receptor antagonist(MRA),diuretics and digitalis from 2002 to 2004,and main-tained at the maximum tolerated doses between 2004 and 2019.Our safety targets to maintain heart rate and blood pressure at 60-80 beats/min and 90-120/60-80 mmHg,respectively.All-cause mortality in the first five years was 55.9%.The independent risk factors for the 5-year mortality were age≥70 years old(OR=5.45,P=0.006),systolic blood pressure(SBP)>120 mmHg(OR=3.63,P=0.004),6-minute walk distance(6MWD)<450 m(OR=3.84,P=0.001).15-year all-cause mortality was 65.8%.The inde-pendent risk factors for 15-year mortality were age≥70 years old(OR=16.07,P=0.009),LVEF≤35%(OR=5.69,P=0.003),and SBP>120 mmHg(OR=9.56,P<0.001).CONCLUSIONS This study was the first to demonstrate the 15-year survival rate of 34%in DCM patients.The DCM patients’first five-year all-cause mortality decreased significantly after continuous standardized treatment and intensive management.The mortality then plateaued in the following 10 years.Age≥70 years,LVEF≤35%,and SBP>120 mmHg were independent predict-ors of 15-year all-cause mortality.