Atrioventricular junction ablation and pacing offers robust control of ventricular rate and improves symptoms, quality of life, and exercise capacity in patients with refractory atrial fibrillation.
Does atrioventricular junction ablation with permanent pacemaker implantation improve rate control and symptoms in patients with refractory atrial fibrillation compared to pharmacological therapy alone?
Atrioventricular junction ablation and pacing is an effective strategy for rate control and symptom improvement in patients with refractory atrial fibrillation, particularly those with reduced systolic function.
Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called "ablate and pace" approach offers the potential for more robust control of ventricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic function. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implantation time, and the proper device selection after atrioventricular junction ablation are also discussed.
Vlachos et al. (Tue,) conducted a review in Atrial fibrillation. Atrioventricular junction ablation and pacing vs. Pharmacological therapy alone was evaluated. Atrioventricular junction ablation and pacing offers robust control of ventricular rate and improves symptoms, quality of life, and exercise capacity in patients with refractory atrial fibrillation.