An Approach to “Ablate and Pace”:AV Junction Ablation and Pacemaker Implantation Performed Concurrently from the Same Venous Access Site

Background: Atrioventricular junction (AVJ) ablation combined with permanent pacemaker implantation (the “ablate and pace” approach) remains an acceptable alternative treatment strategy for symptomatic, drug‐refractory atrial fibrillation (AF) with rapid ventricular response. This case series describes the feasibility and safety of catheter ablation of the AVJ via a superior vena caval approach performed during concurrent dual‐chamber pacemaker implantation. Methods: A total of 17 consecutive patients with symptomatic, drug‐refractory, paroxysmal AF underwent combined AVJ ablation and dual‐chamber pacemaker implantation procedure using a left axillary venous approach. Two separate introducer sheaths were placed into the axillary vein. The first sheath was used for implantation of the pacemaker ventricular lead, which was then connected to the pulse generator. Subsequently, a standard ablation catheter was introduced through the second axillary venous sheath and used for radiofrequency (RF) ablation of the AVJ. After successful ablation, the catheter was withdrawn and the pacemaker atrial lead was advanced through that same sheath and implanted in the right atrium. Results: Catheter ablation of the AVJ was successfully achieved in all patients. The median number of RF applications required to achieve complete AV block was three (range 1–10). In one patient, AV conduction recovered within the first hour after completion of the procedure, and AVJ ablation was then performed using the conventional femoral venous approach. There were no procedural complications. Conclusion: Catheter ablation of the AVJ can be performed successfully and safely via a superior vena caval approach in patients undergoing concurrent dual‐chamber pacemaker implantation.