{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:11:31Z","timestamp":1760058691899,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wroc\u0142aw Medical University","award":["SUBZ.L030.25.052"],"award-info":[{"award-number":["SUBZ.L030.25.052"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Permanent atrial fibrillation (AF) frequently coexists with heart failure (HF), leading to structural remodeling and progressive sinus node dysfunction. As the condition advances, bradyarrhythmia or tachy-brady syndrome may develop. Right ventricular pacing and cardiac resynchronization therapy may impair left ventricular function due to non-physiological ventricular activation. His bundle pacing (HBP) offers a more physiological alternative. This study evaluates HBP\u2019s impact on left ventricular function in patients with bradyarrhythmia or tachy-brady syndrome and permanent AF. Methods: A retrospective analysis included 41 patients with HF who underwent HBP implantation due to bradyarrhythmia or tachy-brady syndrome in permanent AF. LVEF, LVEDD, and MR were assessed before and after implantation, alongside the impact of comorbidities (e.g., ischemic heart disease and chronic kidney disease) and pharmacotherapy (digoxin, metoprolol, and mineralocorticoid receptor antagonists). Statistical analyses included the Wilcoxon test (LVEF and MR), paired Student\u2019s t-test (LVEDD), Spearman\u2019s correlation, and linear regression. Significance was set at p &lt; 0.05. Results: HBP significantly improved LVEF (median increase: 14.58%; p &lt; 0.001) and reduced LVEDD (mean reduction: 5.41 \u00b1 1.30 mm; p &lt; 0.001). MR severity also decreased (p &lt; 0.001). Patients with lower baseline LVEF showed greater improvement in this parameter after HBP (\u03c1 = \u22120.671, p &lt; 0.001). Only chronic kidney disease was associated with a lower likelihood of MR improvement (p = 0.0486). Conclusions: HBP improves left ventricular function and reduces MR severity in patients with permanent AF and bradyarrhythmia or tachy-brady syndrome. A low baseline LVEF was the strongest predictor of subsequent improvement. Further studies are needed to confirm long-term benefits.<\/jats:p>","DOI":"10.3390\/jcm14092860","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T02:00:53Z","timestamp":1745287253000},"page":"2860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["His Bundle Pacing Improves Left Ventricular Function in Patients with Bradyarrhythmia or Tachy-Brady Syndrome and Permanent Atrial Fibrillation: A Retrospective Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5701-9349","authenticated-orcid":false,"given":"Patrycja","family":"Paluszkiewicz","sequence":"first","affiliation":[{"name":"Department of Emergency Medical Service, Wroclaw Medical University, ul. Parkowa 34, 51-616 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-6380","authenticated-orcid":false,"given":"Adrian","family":"Martuszewski","sequence":"additional","affiliation":[{"name":"Division of Environmental Health and Occupational Medicine, Department of Population Health, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1427-4796","authenticated-orcid":false,"given":"Jacek","family":"Smereka","sequence":"additional","affiliation":[{"name":"Department of Emergency Medical Service, Wroclaw Medical University, ul. Parkowa 34, 51-616 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Gajek","sequence":"additional","affiliation":[{"name":"Medical Faculty, Wroc\u0142aw University of Science and Technology, 50-368 Wroc\u0142aw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1016\/j.jacc.2016.08.048","article-title":"Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation","volume":"68","author":"Kotecha","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101556","DOI":"10.1016\/j.jacadv.2024.101556","article-title":"Heart Failure in Atrial Fibrillation Subtypes in Women and Men in the Troms\u00f8 Study","volume":"4","author":"Espnes","year":"2025","journal-title":"JACC Adv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.jacc.2023.12.033","article-title":"Implications of Atrial Fibrillation for Guideline-Directed Therapy in Patients with Heart Failure","volume":"83","author":"Newman","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvc.2018.10.004","article-title":"Canine and Human Sinoatrial Node: Differences and Similarities in the Structure, Function, Molecular Profiles, and Arrhythmia","volume":"22","author":"Kalyanasundaram","year":"2019","journal-title":"J. Vet. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.tcm.2016.04.012","article-title":"Mechanistic Insights into Mitral Regurgitation Due to Atrial Fibrillation: \u201cAtrial Functional Mitral Regurgitation\u201d","volume":"26","author":"Liang","year":"2016","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.1016\/j.jcmg.2022.08.016","article-title":"Atrial Functional Mitral Regurgitation","volume":"15","author":"Zoghbi","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/14779072.2022.2050695","article-title":"A Comparison of Medical Therapy and Ablation for Atrial Fibrillation in Patients with Heart Failure","volume":"20","author":"Calvert","year":"2022","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1161\/CIRCULATIONAHA.121.057095","article-title":"Randomized Ablation-Based Rhythm-Control Versus Rate-Control Trial in Patients with Heart Failure and Atrial Fibrillation: Results from the RAFT-AF Trial","volume":"145","author":"Parkash","year":"2022","journal-title":"Circulation"},{"key":"ref_9","first-page":"367","article-title":"A Conversion CRT Strategy Combined with AVJA May Be a Perspective Alternative for Heart Failure Patients with Persistent Atrial Fibrillation","volume":"28","author":"Chen","year":"2023","journal-title":"Heart Fail. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1080\/00015385.2021.1901021","article-title":"The Clinical Utility of Direct His-Bundle Pacing in Patients with Heart Failure and Permanent Atrial Fibrillation","volume":"77","author":"Ciesielski","year":"2022","journal-title":"Acta Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s10840-024-01882-z","article-title":"Clinical Outcomes of Conduction System Pacing Compared to Biventricular Pacing in Patients with Mid-Range Ejection Fraction","volume":"68","author":"Tang","year":"2024","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s12170-021-00684-6","article-title":"Patient Selection for Biventricular Cardiac Resynchronization Therapy, His Bundle Pacing, and Left Bundle Branch Pacing","volume":"15","author":"Sanders","year":"2021","journal-title":"Curr. Cardiovasc. Risk Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1016\/j.hrthm.2018.10.035","article-title":"Impact of Physiologic Pacing versus Right Ventricular Pacing among Patients with Left Ventricular Ejection Fraction Greater than 35%: A Systematic Review for the 2018 ACC\/AHA\/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay","volume":"16","author":"Slotwiner","year":"2019","journal-title":"Heart Rhythm."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2964","DOI":"10.1111\/jce.14763","article-title":"Within-patient Comparison of His-bundle Pacing, Right Ventricular Pacing, and Right Ventricular Pacing Avoidance Algorithms in Patients with PR Prolongation: Acute Hemodynamic Study","volume":"31","author":"Keene","year":"2020","journal-title":"Cardiovasc. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1111\/pace.14289","article-title":"Brady-arrhythmias in Patients with Atrial Fibrillation and Heart Failure of Reduced Ejection Fraction: Is His-bundle Pacing Superior to Biventricular Pacing?","volume":"44","author":"Ma","year":"2021","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"748","DOI":"10.5603\/CJ.a2022.0079","article-title":"The Usefulness of His Bundle Pacing in a Heterogeneous Population of Patients with Impaired Left Ventricular Systolic Function","volume":"31","author":"Gardas","year":"2024","journal-title":"Cardiol. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1111\/pace.14478","article-title":"Impact of Baseline Left Ventricular Ejection Fraction on Long-term Outcomes in Cardiac Contractility Modulation Therapy","volume":"45","author":"Fastner","year":"2022","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/j.jacc.2019.02.061","article-title":"Atrial Functional Mitral Regurgitation","volume":"73","author":"Deferm","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1016\/j.jacc.2022.09.046","article-title":"Pathophysiology, Echocardiographic Diagnosis, and Treatment of Atrial Functional Mitral Regurgitation","volume":"80","author":"Farhan","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.hjc.2022.09.013","article-title":"Incidence and Causal Association of Functional Atrial Mitral Regurgitation in HFpEF","volume":"69","author":"Kouris","year":"2023","journal-title":"Hell. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.hroo.2021.07.007","article-title":"Impact of Physiological Pacing on Functional Mitral Regurgitation in Systolic Dysfunction: Initial Echocardiographic Remodeling Findings after His Bundle Pacing","volume":"2","author":"Upadhyay","year":"2021","journal-title":"Heart Rhythm O2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3245","DOI":"10.1111\/jce.15269","article-title":"His-Purkinje Conduction System Pacing: A Systematic Review and Network Meta-analysis in Bradycardia and Conduction Disorders","volume":"32","author":"Qu","year":"2021","journal-title":"Cardiovasc. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s10840-018-0412-5","article-title":"His Bundle Pacing","volume":"52","author":"Payne","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_25","first-page":"245","article-title":"Improvement of Left Ventricular Function by Permanent Direct His-Bundle Pacing in a Case with Dilated Cardiomyopathy","volume":"22","author":"Sashida","year":"2006","journal-title":"J. Arrhythmia"},{"key":"ref_26","first-page":"1119","article-title":"His Bundle Pacing Is Continually Relevant for Patients with Atrial Fibrillation and Bradycardia without Prior Atrioventricular Nodal Ablation, Data from Mid-Term Follow-Up","volume":"82","author":"Soral","year":"2024","journal-title":"Pol. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1111\/jce.14490","article-title":"Network Meta-analysis of His Bundle, Biventricular, or Right Ventricular Pacing as a Primary Strategy for Advanced Atrioventricular Conduction Disease with Normal or Mildly Reduced Ejection Fraction","volume":"31","author":"Fernandes","year":"2020","journal-title":"Cardiovasc. Electrophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/j.jelectrocard.2018.10.091","article-title":"The Optimal Management of Patient with Permanent Atrial Fibrillation and Heart Failure with Reduced Ejection Fraction\u2014The Permanent His-Bundle Pacing Is a Solution. A Case Report","volume":"51","author":"Skonieczny","year":"2018","journal-title":"J. Electrocardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1016\/S0140-6736(14)62340-0","article-title":"\u03b2 Blockers, Atrial Fibrillation, and Heart Failure","volume":"384","author":"McMurray","year":"2014","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1016\/S0140-6736(14)61373-8","article-title":"Efficacy of \u03b2 Blockers in Patients with Heart Failure plus Atrial Fibrillation: An Individual-Patient Data Meta-Analysis","volume":"384","author":"Kotecha","year":"2014","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jchf.2012.09.002","article-title":"Beta-Blockers and Outcome in Heart Failure and Atrial Fibrillation","volume":"1","author":"Rienstra","year":"2013","journal-title":"JACC Heart Fail."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1016\/j.clinthera.2015.08.017","article-title":"Should \u03b2-Blockers Be Used in Patients With Heart Failure and Atrial Fibrillation?","volume":"37","author":"Mareev","year":"2015","journal-title":"Clin. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jchf.2014.01.005","article-title":"Is Heart Rate Important for Patients With Heart Failure in Atrial Fibrillation?","volume":"2","author":"Cullington","year":"2014","journal-title":"JACC Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s10840-018-0429-9","article-title":"Atrial Fibrillation and Conduction System Disease: The Roles of Catheter Ablation and Permanent Pacing","volume":"52","author":"Thiyagarajah","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e13583","DOI":"10.1111\/ijcp.13583","article-title":"\u201cPreventive\u201d Pacing in Patients with Tachy-brady Syndrome (TBS): Confirming a Common Practice","volume":"74","author":"Amir","year":"2020","journal-title":"Int. J. Clin. Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2860\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:19:03Z","timestamp":1760030343000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/9\/2860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14092860"],"URL":"https:\/\/doi.org\/10.3390\/jcm14092860","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,4,22]]}}}