AV node ablation and implantation of mode switching dual chamber pacemakers: effective treatment for drug refractory PAF

Editor,—Marshall et al state that the combined procedure of atrioventricular (AV) node ablation and permanent pacemaker insertion for medically refractory paroxysmal atrial fibrillation (PAF) is justified on the basis of their study results.1 We agree that in many patients with this condition AV node ablation and pacemaker insertion can improve the perceived quality of life; however, we feel that it is in the patient’s best interest that this procedure be performed in a staged manner with at least one month between pacemaker insertion and ablation. Lau et al previously identified a group of patients with drug resistant PAF in whom DDDR pacing prevented the need for subsequent AV node ablation.2 Their conclusion was that up to a third of patients with drug refractory PAF may derive benefit from sensor driven atrial pacing alone and that this treatment can result in an improvement in patient perceived quality of life, without additional AV node ablation. Permanent blockade of the AV node results in lifelong ventricular …