title: Endocardial transcatheter stimulation of the AV nodal fat pad: stabilization of rapid ventricular rate response during atrial fibrillation in left ventricular failure.
abstract: BACKGROUND
  Recent acute studies demonstrated that atrioventricular (AV) node vagal stimulation during atrial fibrillation (AF) decreases the mean ventricular rate, thus improving hemodynamics.
  
  
  RESULTS
  We report a case of a woman with acute heart failure (HF), chronic AF with untreatable ventricular rapid response, in severe hypotensive state due to a cardiogenic shock. The patient underwent left ventricular (LV) pacemaker implantation and received 50 Hz AV node stimulation, delivered through a posteroseptal atrial lead, thus allowing a 100% pacing. Hemodynamics improvements allowed carvedilol titration; the rate was below 85 bpm after 4 days, then the atrial lead was removed.
  
  
  CONCLUSIONS
  This novel strategy may allow controlling the rapid AV response in patients undergoing pacemaker implantation.
authors.affiliation: Division of Cardiology, S. Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy. stefbianchi@gmail.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Bianchi
authors.forename: Pietro
authors.initials: P
authors.lastname: Rossi
authors.forename: Alberto
authors.initials: A
authors.lastname: Della Scala
authors.forename: Lilian
authors.initials: L
authors.lastname: Kornet
mesh_terms: D000273:Adipose Tissue / Q000601:surgery*; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004699:Endocardium / Q000601:surgery; D005260:Female; D006801:Humans; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000601:surgery*