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Outcomes of Atrioventricular Node Ablation and Pacing in Patients with Heart Failure and Atrial Fibrillation: From

Ioanna Koniari1, Andreas Gerakaris2, Nicholas Kounis3

  • 1Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.

Journal of Cardiovascular Development and Disease
|July 28, 2023
PubMed

Insights

Atrioventricular node ablation and pacing improve outcomes for heart failure patients with atrial fibrillation. Cardiac resynchronization therapy is preferred, with His bundle pacing as a promising alternative.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Atrial fibrillation and heart failure often coexist, complicating management.
  • Medical therapy may be insufficient for some patients, necessitating alternative interventions.

Purpose of the Study:

  • To review literature on atrioventricular node ablation and pacing in patients with heart failure and atrial fibrillation.
  • To assess clinical outcomes and complications associated with these interventions.

Main Methods:

  • Conducted a comprehensive literature search using PubMed/MEDLINE and SCOPUS.
  • Evaluated clinical trials, observational studies, and meta-analyses.
  • Focused on outcomes such as symptom improvement, cardiac performance, and safety.

Main Results:

  • The "pace and ablate" strategy improves symptoms and cardiac performance in heart failure patients with atrial fibrillation.
  • Cardiac resynchronization therapy is superior to right ventricle apical pacing.
  • His bundle pacing and left bundle branch pacing show promise as innovative pacing modalities.
  • Potential complications include worsening heart failure, arrhythmias, and sudden death.

Conclusions:

  • Atrioventricular node ablation and pacing offer significant benefits for patients with atrial fibrillation and/or heart failure refractory to medical treatment.
  • Cardiac resynchronization therapy is the optimal pacing choice.
  • His bundle pacing presents an effective alternative pacing strategy.

Keywords:
His bundle pacingatrial fibrillationatrioventricular node ablationcardiac resynchronization therapyheart failure

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