Atrioventricular junction ablation in atrial fibrillation: Choosing the right patient and pacing device

Finn Akerström, Moisés Rodríguez-Mañero, Marta Pachón, Alberto Puchol, Xesús Alberte Fernández-López, Luis Martínez-Sande, Miguel Valderrábano, Miguel A. Arias

Research output: Contribution to journalReview article

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)31-38
Number of pages8
JournalJournal of Atrial Fibrillation
Volume8
Issue number2
StatePublished - Aug 1 2015

Keywords

  • AV Junction Ablation
  • Atrial Fibrillation
  • CRT
  • Cardiac Resyncrhonization
  • Pacing
  • Therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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