Ablate and pace: The ultimate treatment for atrial fibrillation?

Atrial fibrillation (AF) has become a major epidemic and is associated with increased morbidity and mortality.Pacemaker treatment combined with atrioventricular junction (AVJ) ablation is an effective treatment in patients with atrial arrhythmias and symptoms due to high ventricular rate refractory to pharmacological treatment. 1nother group that benefits from AVJ ablation are patients with heart failure (HF), AF and cardiac resynchronization therapy (CRT) with a low percentage of biventricular pacing.AVJ ablation has been shown to increase the percentage of biventricular pacing and thus increase the therapeutic effects of CRT. 2 However, AVJ ablation is not without risks.Right ventricular pacing induces left ventricle dyssynchrony that in turn impairs cardiac function.There is also an increased risk of sudden death after AVJ ablation. 3On the other hand, the long-term performance of pacing devices is not flawless. 4ence the pertinence of long-term results after use of the ablate and pace strategy.The article by Manuel et al. in this issue of the Journal 5 illustrates the retrospective experience of a Portuguese tertiary center and the longest follow-up ever published after AVJ ablation.The authors followed a very heterogeneous population of 123 patients who underwent AVJ ablation for a median period of 8.5 years (8.8-11.8).Most of the patients presented uncontrolled supraventricular tachycardia that resulted in HF, tachycardiomyopathy, implantable