Atrial fibrillation (AF) is the most common cardiac
arrhythmia and despite advancements in rhythm control through direct catheter
ablation, maintaining sinus rhythm is currently not possible in a large
proportion of AF patients. Furthermore, in some instances pharmacological rate
control may be insufficient, resulting in a highly symptomatic patient 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 those 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.
Credits: Finn Akerström; Moisés Rodríguez-Mañero; Marta Pachón; Alberto Puchol; X. Alberte Fernández-López; Luis Martínez-Sande; Miguel Valderrábano MD; Miguel A. Arias.