Ablate and Pace Therapy or AV Junction Modification for Medically Refractory Atrial Fibrillation?
Currently available nonpharmacological techniques for ventricular rate control in patients with drug refractory atrial fibrillation (AF) include radiofrequency ablation of the atrioventricular (AV) junction with pacemaker implantation [1–4] and modulation of AV node conduction [5–8]. The former is an already established approach with a high success rate and predictable long-term effects; it also has limitations that include a nonphysiological pattern of ventricular activation and possible risk of late sudden death [9, 10]. Modulation of the AV node conduction has been introduced more recently into clinical practice, and, although it eliminates lifetime pacemaker dependence, it is less widely accepted because of a lower acute success rate, risk of inadvertent AV block, and persistence of irregular heartbeat. Since recent randomized studies [10, 11] comparing acute and medium term outcomes of the two techniques have given contrasting results, at the present time the relative merits of the two techniques are not well defined.
KeywordsAtrial Fibrillation Pacemaker Implantation Atrioventricular Junction Pace Therapy Slow Pathway Ablation
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