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

Atrioventricular nodal (AVN) ablation with permanent pacemaker implantation - 'pace and ablate' - may be considered for patients with symptomatic atrial fibrillation (AF) for whom rhythm control has been unsuccessful. This creates concerns about inducing pacemaker dependence and potential pacemaker-induced cardiomyopathy (PICM). Conduction-system pacing mitigates PICM, so we expect a greater uptake of AVN ablation going forward. We conducted a retrospective multicentre review of our patients who underwent AVN ablation over a one-year period. AVN ablation was successful with durable lesions at one year. Radiofrequency energy was utilised in all patients, with a median application time of 2.67 minutes. Median procedure time was found to be 55.5 minutes and fluoroscopy median of 3.5 minutes. Median radiation dose was 11 mGy. We found no acute or subacute complications up to three months. In conclusion, our right-sided approach for ablation, staged post-device insertion demonstrated results in keeping with other centres in the UK and Europe. We expect our current practice to become more widespread, given the increased risk of lead-related complications or failures associated with physiological pacing compared with standard pacing methods.