Enhancing Cardiac Resynchronization Therapy for Patients with Atrial Fibrillation: The Role of AV Node Ablation

Journal of Atrial Fibrillation
Jeff M Berry, Jose AJoglar

Abstract

Cardiac resynchronization therapy (CRT) has evolved as an effective therapy for patients with congestive heart failure (CHF) and ventricular dyssynchrony, currently defined as a wide QRS on the electrocardiogram. While multiple randomized controlled trials have confirmed the favorable effects of CRT on mortality and heart failure symptoms for patients in sinus rhythm, only recently observational studies have begun to suggest a similar benefit for patients with atrial fibrillation (AF) and dyssynchrony. Yet, implementing effective biventricular pacing in patients with AF can be problematic due to competing intrinsic AV conduction. For patients with depressed ejection fractions needing AV node (AVN) ablation to control fast ventricular rates, biventricular pacing has been shown to be superior to right ventricular pacing alone. When consistent pacing (over 90% of the time) cannot be achieved in AF patients due to a rapid ventricular response despite pharmacological therapy, AVN ablation should be considered. The additional benefit of performing AVN ablation to promote biventricular pacing in patients without rapid ventricular rates remains uncertain. A randomized controlled trial is needed to test the incremental benefit of AVN ab...Continue Reading

Related Concepts

Related Feeds

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Cardiac Conduction System

The cardiac conduction system is a specialized tract of myocardial cells responsible for maintaining normal cardiac rhythm. Discover the latest research on the cardiac conduction system here.