title: Atrioventricular Junction Ablation In Atrial Fibrillation: Choosing The Right Patient And Pacing Device.
abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is not possible in a large proportion of AF patients, who therefore are subject to a rate control strategy only. Nonetheless, in some of these patients pharmacological rate control may be ineffective, often leaving the patient highly symptomatic and at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF). Catheter ablation of the atrioventricular junction (AVJ) with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In patients with reduced ventricular function, cardiac resynchronization therapy (CRT) should be considered over right ventricular apical (RVA) pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Finn
authors.initials: F
authors.lastname: Akerström
authors.affiliation: Cardiac Electrophysiology, Department of Cardiology. Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas.
authors.forename: Moisés Rodríguez
authors.initials: MR
authors.lastname: Mañero
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Pachón
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Puchol
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain.
authors.forename: Xesús Alberte Fernández
authors.initials: XA
authors.lastname: López
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain.
authors.forename: Luis Martínez
authors.initials: LM
authors.lastname: Sande
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Valderrábano
authors.affiliation: Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arias
keywords: AV Junction Ablation; Atrial Fibrillation; CRT; Cardiac Resyncrhonization Therapy; Pacing