Pace and ablate: The ultimate treatment for atrial fibrillation?

Atrial fibrillation (AF) has become a major epidemic and is associated with high morbidity and mortality.Pacemaker treatment combined with atrioventricular (AV) node 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 AV node ablation is patients with heart failure (HF), AF and cardiac resynchronization therapy (CRT) with a low percentage of biventricular pacing.AV node ablation has been shown to increase the percentage of biventricular pacing and thus enhance the therapeutic effects of CRT. 2 However, AV node ablation is not without risks.Right ventricular pacing induces left ventricular dyssynchrony, which in turn impairs cardiac function.There is also an increased risk of sudden death after AV node ablation. 3In addition, the long-term performance of pacing devices is not flawless. 4ence the relevance of long-term results after a pace-andablate strategy.The article by Manuel et al. in this issue of the Journal 5 describes the retrospective experience of a Portuguese tertiary center with the longest follow-up ever published after AV node ablation.The authors followed a highly varied population of 123 patients who had undergone AV node ablation for a median of 8.5 years (8.8-11.8).