AV nodal ablation, where are we now? Insight from real-world Northern Irish multi-centre registry data

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrioventricular nodal (AVN) ablation with permanent pacemaker implantation, known as 'pace and ablate', is an option for symptomatic atrial fibrillation (AF) refractory to rhythm control.
• Concerns exist regarding pacemaker dependence and potential pacemaker-induced cardiomyopathy (PICM).
• Conduction-system pacing is recognized for its potential to mitigate PICM, suggesting a future increase in AVN ablation procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of a retrospective, multicentre AVN ablation approach over a one-year period.
• To assess the durability of ablation lesions and procedural outcomes.
• To compare findings with existing data from UK and European centres.

Main Methods:

• Retrospective review of patients undergoing AVN ablation over one year.
• Utilisation of radiofrequency energy for ablation.
• Staged approach with device insertion preceding ablation.

Main Results:

• Successful AVN ablation with durable lesions observed at one year.
• Median radiofrequency application time: 2.67 minutes.
• Median procedure time: 55.5 minutes; median fluoroscopy time: 3.5 minutes; median radiation dose: 11 mGy.
• No acute or subacute complications noted up to three months post-procedure.

Conclusions:

• The right-sided AVN ablation approach, performed after device insertion, yields results comparable to other centres.
• The procedure demonstrated safety and efficacy, with durable lesions at one year.
• This practice is anticipated to become more prevalent due to risks associated with physiological pacing compared to standard methods.