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HFrEF with Refractory AF Rate Control — EECC MCQ

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HardHeart FailureHFrEF with Refractory AF Rate ControlEECC

A patient with complete AV block, normal LVEF and an anticipated lifelong pacing burden asks about left-bundle-area pacing. What is the principal rationale?

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Correct answer: CRecruit the native conduction system to preserve synchrony

Conduction-system pacing seeks to activate the ventricles through the His–Purkinje network and reduce dyssynchrony from conventional RV pacing. It may be especially attractive with a high expected pacing burden, although implant complexity, thresholds, anatomy and long-term evidence must be considered. It does not provide defibrillation by itself. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: 2021 ESC Guidelines on cardiac pacing and CRT. https://www.escardio.org/guidelines/clinical-practice-guidelines/cardiac-pacing-and-cardiac-resynchronization-therapy/