AIM  To discuss the effects of His bundle pacing (HBP), including biventricular + His bundle pacing (BiV/HBP) and right ventricle + His bundle pacing (RVP/HBP) on the cardiac functions in atrial fibrillation (AF) patients with heart failure with decreased ejection fraction (HFrEF).

  METHODS  Retrospective analysis was performed on 26 AF patients combined with HFrEF who underwent HBP and the patients were divided into two groups according to their surgical methods: group A (20 cases, BIV/HBP) and group B (6 cases, RVP/HBP). The changes of cardiac chamber size, cardiac functions and ECG, myocardial injury markers, biochemical ion levels and parameters of electrode conductors in the two groups before and after treatment were recorded.

  RESULTS  HBP therapy shrinked the heart cavity and improved the cardiac functions in AF patients combined with HFrEF. Compared with the RVP/HBP group, patients in the BIV/HBP group had larger left ventricle and worse cardiac functions preoperatively, but there were no significant differences in cardiac chamber size and cardiac function between the two groups after treatment. Postoperative cardiac function LVEF was positively correlated with preoperative LVEF and was negatively correlated with preoperative ESV, EDV, left ventricular size and QRS width.

  CONCLUSION  It is feasible to use His pacing in treatment of AF patients combined with HFrEF. For patients with significantly enlarged heart and worse cardiac functions (LVEF<35 %), BIV/HBP can bring more significant clinical benefits than RVP/HBP in patients with wider QRS.