Pacemaker Dependence After Atrioventricular Node Ablation

Chapter

Abstract

Atrial fibrillation is related to increased risk of stroke and heart failure and is a growing health issue with the aging of the world population. Rate control strategy for atrial fibrillation is not inferior to rhythm control strategy in patients with and without heart failure, however could be difficult to achieve with pharmacological agent alone even with the latest, more lenient target of rate control of below 110 beats per minute. Atrial fibrillation especially with uncontrolled heart rate could be associated with tachycardia-mediated cardiomyopathy which can be reversible. Non-pharmacological method for rate control includes atrioventricular node modification, atrioventricular node ablation with permanent pacing, and selective vagal stimulation. Atrioventricular node ablation with permanent pacing is the most well-established method with evidence showing different degrees of improvement in left ventricular function. However, some of the early beneficial effect was cancelled out by the deleterious effect of dyssynchrony induced by right ventricular pacing. The beneficial effect is more pronounced and sustained in atrial fibrillation patients with heart failure receiving cardiac resynchronization therapy. Atrioventricular node ablation and biventricular pacing could turn out to be the superior non-pharmacological method of atrial fibrillation rate control.

Keywords

Atrial fibrillation Atrioventricular nodal ablation Pacemaker Dependence Cardiac resynchronization therapy 

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© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Medicine and TherapeuticsPrince of Wales Hospital, The Chinese University of Hong KongShatin, N.T.Hong Kong

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