Atrioventricular junctional ablation: The good, the bad, the better

BACKGROUND: The management of patients with atrial fibrillation and an abnormally fast ventricular response has been through the use of pharmacologic agents. In those cases where rate control cannot be achieved pharmacologically, a standard approach has been atrioventricular (AV) junctional ablation and ventricular pacemaker implantation to achieve a stable ventricular rate. Long-term ventricular pacing has been shown to result in diminished ventricular function that can lead to heart failure. OBJECTIVE: To describe an experimental and clinical study demonstrating a modified form of AV junction ablation. METHODS: Ablation of the slow and fast AV nodal input does not produce AV block. Ablation of the connection between the two induces AV block, leaving the AV node and His bundle intact. RESULTS: Subsequently the escape heart rate is close to normal and responds well to exercise. CONCLUSION: In a clinical study with a 42 month follow-up, the modified procedure resulted in significantly reduced pacemaker dependence and mortality compared to the standard AV ablation procedure.