Pacing in First-degree AV-block

The purpose of this study is to explore if there is a less harmful way to pace patients with
first-degree AV-block to ensure that the negative effects inferred by the pacing do not
outweigh the positive effects of AV-synchrony. The main hypothesis of the study is that
His-bundle pacing will offer a more physiological mode of pacing in patients with
first-degree AV-block than conventional pacing.

Patients scheduled for catheter ablation of atrial fibrillation (AF) in sinus rhythm, with
first degree AV-block, normal QRS duration less than 120 ms and normal left ventricular
ejection fraction will be included. During the AF ablation three different pacing modes
(atrial, AV-synchronous and His-bundle pacing) at two different rates (5 to10 bpm above the
basal rate and at 100 bpm) will be performed and evaluated using echocardiography. After the
completion of all six pacing protocols (i.e., three modes at two different rates) the
experimental part of the procedure ends.

The primary end-point will be echocardiographic evidence of dyssynchrony. Secondary
end-points will include left ventricular ejection fraction, left ventricular volume, mitral
regurgitation, septal to posterior wall motion delay and inter-ventricular wall motion delay.
Since the research study is conducted in parallel with the standard catheter ablation, we do
not anticipate any additional side effects as a result of the study.