Benefits of Simultaneous Pacing Left Anterior/Posterior Fascicular Areas Combined with Atrioventricular Node Ablation in a Persistent Atrial Fibrillation Patient with Heart Failure: A Case Report

A 50-year-old male had intermittent episodes of dyspnea for 7 days with persistent atrial fibrillation (AF) for 2 years. New York Heart Association (NYHA) functional class is IV status. The echocardiographic evaluation (Philps EPIQ 7C, S5-1 probe, 1.0-5.0 MHz) was performed showing a left ventricular ejection fraction (LVEF) of 48% (measured by the Simpson biplane method). His-Purkinje conduction system pacing (HPCSP) may enhance electrical resynchronization as well as the clinical and echocardiographic outcomes of patients with advanced heart failure (HF) who require resynchronization therapy (CRT). The use of left anterior fascicular areas pacing/left posterior fascicular areas pacing (LAFAP/LPFAP) may offer a significant advantage in patients for whom both biventricular pacing (BVP) and His bundle pacing (HBP) have not delivered substantial therapeutic benefits. In this study, we optimized electrical resynchronization by combining the concept of fused simultaneous pacing of LAFA/LPFA with an atrioventricular node ablation (AVNA) in a patient with HF and atrial fibrillation (AF). The maximal electrical resynchronization presented better hemodynamic and demonstrated comparable clinical and echocardiographic responses.