Even when transcatheter AV junctional ablation fails to induce permanent complete heart block initially, late high degree heart block can occur, highlighting the need for systematic pacemaker implantation.
Late high-degree AV block may occur after failed ablation despite initial 1:1 conduction; leaves open whether routine pacing is warranted.
We report on two patients out of a series of 22 who underwent transcatheter ablation of the atrioventricular (AV) junction. The procedure failed to induce permanent complete heart block in 15 patients, 12 of whom were in sinus rhythm with 1:1 AV conduction before hospital discharge. Of the 12 patients, two (16.6%) were found to be in high degree heart block, one month later. We discuss the mechanism of late occurrence of high degree heart block and we emphasize the need for systematic implantation of permanent ventricular or dual chamber pacemakers, despite failure of transcatheter ablation of the AV junction.
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Bru et al. (1987) studied this question.
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