title: Long-term follow-up in AV junction ablation via the SVC in patients undergoing concurrent device implantation: a single center experience.
abstract: BACKGROUND
  Ablation of the atrioventricular junction (AVJ) combined with pacemaker implantation (the "ablate and pace" approach) has been an effective treatment strategy for patients with atrial fibrillation (AF) when rate control is the goal of therapy and when rapid ventricular rates during AF is refractory to pharmacologic therapy.
  
  
  OBJECTIVE
  This report describes the feasibility and safety of catheter ablation of AVJ via a superior vena cava (SVC) approach performed during concurrent pacemaker or defibrillator implantation.
  
  
  METHODS
  A total of 170 consecutive patients with drug-refractory AF underwent combined AVJ ablation and pacemaker or defibrillator implantation using the axillary or subclavian venous approach. The acute and long-term success of achieving complete atrioventricular (AV) block, the impact of the ablation procedure on the total procedure time and fluoroscopy duration, and procedural complications were evaluated.
  
  
  RESULTS
  A dual-chamber device in 61% of patients and biventricular device in 39% patients. Catheter ablation of the AVJ was acutely successful in 166 patients (97.6%). The mean procedure time of the AVJ ablation was 7.0 ± 3.3 minutes and the mean fluoroscopy time during the ablation procedure was 3.1 ± 3.2 minutes. The average duration of RF energy application required to achieve complete AV block was 129 ± 65 seconds. Procedural complications were observed in seven patients. Complete AV block persisted in 96% of patients during a mean follow-up of 26 ± 16 months.
  
  
  CONCLUSIONS
  Catheter ablation of the AVJ can be performed successfully and safely using the SVC approach in patients undergoing concurrent device implantation, and it may offer several advantages over the conventional femoral approach.
authors.affiliation: Southern Illinois University, Department of Medicine, Springfield, Illinois; Prairie Cardiovascular Consultants, Springfield, Illinois.
authors.forename: Ziad F
authors.initials: ZF
authors.lastname: Issa
authors.forename: Bashar S
authors.initials: BS
authors.lastname: Amr
authors.forename: Hytham
authors.initials: H
authors.lastname: Laham
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D017147:Defibrillators, Implantable; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery
keywords: atrial fibrillation; atrioventricular junction ablation; pacemaker implantation