Impact of Coronary Dominance on Atrioventricular Node Ablation Approach

Persistent atrial fibrillation often requires atrioventricular node (AVN) ablation when conventional rhythm - or rate-control strategies are unsucessful, but procedural outcomes may be influenced by anatomic variability. We hypothesized that coronary artery dominance affects AVN positioning and the preferred ablation approach. In this retrospective study, 132 patients who underwent AVN ablation and coronary CTA were analyzed. Right coronary dominance was present in 78.8% of patients, left in 13.6% and co-dominant in 7.6%. Patients with left or co-dominant circulation had significantly higher odds of requiring a left-sided approach compared with right-dominant patients (21.4% vs 1.9%, p<0.001), and demonstrated longer mean procedure time (50 vs 34 minutes, p = 0.044). These findings suggest that coronary dominance may influence AVN localization and ablation strategy. Incoroporating coronary dominance assessment into preprocedural imaging may enhance procedural planning, shorten duration and reduce radiation exposure.