Impact of Atrioventricular Node Ablation and Permanent Pacing on Clinical Outcomes, Quality of Life and Healthcare Utilization in Patients with Atrial Fibrillation

Q: What are the key findings of this study?

Atrioventricular node ablation with pacing reduced healthcare utilization across all domains, improved quality of life in 67.0% of patients, and had a 0.8% procedural complication rate.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Refractory atrial fibrillation (n=248). Intervention: Atrioventricular node ablation with permanent pacing (left bundle branch, biventricular, or right ventricular pacing) vs. Pre-ablation baseline (1 year prior to procedure). Primary outcome: 1-year all-cause mortality, quality of life (SF-36), and healthcare utilization per patient-year at 1 year (p=<0.001).

Q: What does this research mean for the field?

Atrioventricular node ablation with permanent pacing is safe, significantly reduces healthcare utilization across diagnostic and treatment domains, and improves quality of life in patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the impact of atrioventricular node ablation (AVNA) on clinical outcomes, quality of life, and healthcare utilization in patients with atrial fibrillation.

Miriam A Scheurwater; Gijs J. van Steenbergen; Leonard M. Rademakers; Daniela N Schulz; Dennis P. A. van Veghel; L R C Dekker

doi:10.1016/j.hroo.2026.03.036

April 1, 2026Heart Rhythm O2Open Access

Impact of Atrioventricular Node Ablation and Permanent Pacing on Clinical Outcomes, Quality of Life and Healthcare Utilization in Patients with Atrial Fibrillation

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Key result

AV node ablation with pacing is linked to reduced healthcare utilization and improved quality of life.

P<0.001
n=248

Figures

Graphical abstract published by Heart Rhythm O2 — Graphical abstract · Published by Heart Rhythm O2 · CC BY

Why the study?

While the impact of AV node ablation on AF symptoms is known, its effects on healthcare utilization and quality of life remain unclear.

Does atrioventricular node ablation combined with permanent pacing improve quality of life and reduce healthcare utilization in patients with refractory atrial fibrillation?

Key Points

To assess the impact of atrioventricular node ablation (AVNA) on clinical outcomes, quality of life, and healthcare utilization in patients with atrial fibrillation.
Retrospective cohort study of 248 patients who underwent AVNA between 2019 and 2024 at a Dutch tertiary referral center.
Pacing modalities included left bundle branch pacing (62.5%), biventricular pacing (19.8%), and conventional right ventricular pacing (17.7%).
Outcomes assessed included clinical complications and mortality, SF-36 quality of life (QoL) at baseline and 1 year, and healthcare utilization per patient-year from 1 year prior to 1 year post-ablation.
Procedural complications were 0.8% (1 infection [0.4%], 1 vascular complication [0.4%]), with 90-day mortality at 4.0% (n = 10) and 1-year mortality at 10.5% (n = 26), none related to the procedure.
At 1 year, QoL improved in 67.0% of evaluated patients (66.7% physical, 67.3% mental) and deteriorated in 14.4% (18.1% physical, 10.6% mental).
Post-AVNA healthcare utilization decreased significantly across all domains, including outpatient visits (-27.5%), emergency department visits (-72.1%), Holter analyses (-84.2%), electrocardiograms (-52.5%), electrical cardioversions (-98.2%), repeat AF ablations (-83.3%), and pacemaker/ICD upgrades (-81.8%; all p < .001).

Study Design

Type

Cohort (n=248)

Multicenter

No

Structured PICO

Does atrioventricular node ablation combined with permanent pacing improve quality of life and reduce healthcare utilization in patients with refractory atrial fibrillation?

P

Population

248 adults (median age 77 years, 55.6% female) with therapy-refractory atrial fibrillation undergoing atrioventricular node ablation and permanent pacing at a Dutch tertiary center, followed for 1 year.

E

Exposure

Atrioventricular node ablation (radiofrequency ablation at the proximal His region until complete permanent AV block) combined with permanent pacemaker implantation: left bundle branch pacing (LBBP, 62.5%), biventricular pacing (19.8%), or conventional right ventricular (RV) pacing (17.7%).

C

Comparator

Pre-AVNA baseline period (1 year before the ablation compared with 1 year after the ablation in a within-patient pre-post analysis; no external control group).

O

Outcome

Clinical outcomes (mortality at 90 days and 1 year, bleeding during admission, thromboembolic complications at 72 hours, pneumothorax during admission, infection within 90 days, vascular complications at 30 days, cardiac tamponade within 30 days, and event-free survival), SF-36 quality of life (QoL) scores at baseline and 1-year follow-up, and healthcare utilization per patient-year (1 year prior vs 1 year post-AVNA).hard clinical

Main Result

p-value: p=<0.001

Atrioventricular node ablation combined with permanent pacing (predominantly left bundle branch pacing) is safe, improves quality of life in two-thirds of patients, and substantially reduces healthcare utilization across all diagnostic, outpatient, emergency, and procedural domains in patients with refractory AF.

Limitations

Retrospective, single-center observational design limiting generalizability
Quality of life analysis was restricted to the 42.3% of patients who completed the SF-36 questionnaire at both baseline and 1-year follow-up, introducing potential survivor and responder bias
Lack of routine EQ-5D data prevented a formal cost-effectiveness analysis
Relatively short-term 1-year follow-up and lack of longitudinal LVEF data prevented evaluation of long-term pacing-induced cardiomyopathy
Retrospective single-center cohort design limiting generalizability
QoL analysis restricted to 42.3% (105/248) of patients who completed SF-36 at both baseline and 1-year follow-up, introducing survivor and responder bias
No routine EQ-5D data collected, precluding formal cost-effectiveness analysis
Relatively short 1-year follow-up and absence of longitudinal LVEF data to assess long-term pacing-induced cardiomyopathy

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Implication

AVNA with pacing was associated with reduced utilization and improved QoL in refractory AF; leaves open need for randomized confirmation before practice change.

Abstract

Background: Atrioventricular node ablation (AVNA) is a class IIa, level B recommendation in the international atrial fibrillation (AF) guidelines.While its impact on symptoms is known, effects on healthcare utilization and quality of life (QoL) remain unclear.Conduction system pacing, particularly left bundle branch pacing (LBBP), may further optimize these outcomes.Objective: To assess the impact of AVNA on clinical outcomes, QoL, and healthcare utilization.Methods: Data from patients who underwent AVNA between 2019 and 2024 at a Dutch tertiary referral center were analyzed.Patients received right ventricular, biventricular, or LBBP.Outcomes included [1] clinical outcomes, [2] SF-36 QoL scores at baseline and one-year follow-up, and [3] healthcare utilization per patient-year one year prior up to one year after AVNA.Results: Of 248 patients (median age 77 years, 44.4% male), most received LBBP (62.5%), followed by biventricular (19.8%) and RV pacing (17.7%).Procedural complications were minimal (0.8%).90days mortality was 4.0% (n = 10) and one-year mortality was 10.5% (n = 26), and deaths were related to heart failure (46.2%) or non-cardiac causes (53.8%).QoL improved in 67.0% and deteriorated in 14.4%.Post-AVNA, healthcare utilization decreased significantly across all domains: outpatient clinic visits (-27.5%)emergency department visits (-72.1%),Holter analyses (-84.2%),electrocardiograms (-52.5%),ECVs (-98.2%),additional AF ablations (-83.3%), and PM/ICD upgrades (-81.8%;all p <.001). Conclusion:AVNA is a safe intervention associated with a significant reduction in healthcare utilization and improved QoL.These findings support AVNA as a valuable strategy for managing AF in an increasingly resource-constrained healthcare environment.

Discussion

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Cite This Study

Scheurwater et al. (2026) conducted a cohort in Refractory atrial fibrillation (n=248). Atrioventricular node ablation with permanent pacing (left bundle branch, biventricular, or right ventricular pacing) vs. Pre-ablation baseline (1 year prior to procedure) was evaluated on 1-year all-cause mortality, quality of life (SF-36), and healthcare utilization per patient-year at 1 year (p=<0.001). Atrioventricular node ablation with pacing reduced healthcare utilization across all domains, improved quality of life in 67.0% of patients, and had a 0.8% procedural complication rate.

synapsesocial.com/papers/69d1fc28a79560c99a0a1d07 https://doi.org/10.1016/j.hroo.2026.03.036

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Impact of Atrioventricular Node Ablation and Permanent Pacing on Clinical Outcomes, Quality of Life and Healthcare Utilization in Patients with Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of Atrioventricular Node Ablation and Permanent Pacing on Clinical Outcomes, Quality of Life and Healthcare Utilization in Patients with Atrial Fibrillation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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