Atrioventricular junction ablation with pacemaker implantation provides effective rate control and symptom relief in refractory atrial fibrillation, with CRT preferred in reduced ejection fraction.
Does atrioventricular junction ablation with permanent pacing improve outcomes in patients with atrial fibrillation refractory to medical therapy or with heart failure?
AVJ ablation followed by CRT is an effective strategy for patients with drug-refractory atrial fibrillation and reduced LVEF, as well as for heart failure patients with AF to ensure near 100% biventricular pacing.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is not possible in a large proportion of AF patients, who therefore are subject to a rate control strategy only. Nonetheless, in some of these patients pharmacological rate control may be ineffective, often leaving the patient highly symptomatic and at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF). Catheter ablation of the atrioventricular junction (AVJ) with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In patients with reduced ventricular function, cardiac resynchronization therapy (CRT) should be considered over right ventricular apical (RVA) pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.
Åkerström et al. (Mon,) conducted a review in Atrial Fibrillation. Atrioventricular junction ablation and pacemaker implantation vs. Pharmacological rate control was evaluated. Atrioventricular junction ablation with pacemaker implantation provides effective rate control and symptom relief in refractory atrial fibrillation, with CRT preferred in reduced ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: