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Pacemaker Dependence After Atrioventricular Node Ablation

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Cardiac Arrhythmias

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Abstract

Atrial fibrillation is related to increased risk of stroke and heart failure and is a growing health issue with the aging of the world population. Rate control strategy for atrial fibrillation is not inferior to rhythm control strategy in patients with and without heart failure, however could be difficult to achieve with pharmacological agent alone even with the latest, more lenient target of rate control of below 110 beats per minute. Atrial fibrillation especially with uncontrolled heart rate could be associated with tachycardia-mediated cardiomyopathy which can be reversible. Non-pharmacological method for rate control includes atrioventricular node modification, atrioventricular node ablation with permanent pacing, and selective vagal stimulation. Atrioventricular node ablation with permanent pacing is the most well-established method with evidence showing different degrees of improvement in left ventricular function. However, some of the early beneficial effect was cancelled out by the deleterious effect of dyssynchrony induced by right ventricular pacing. The beneficial effect is more pronounced and sustained in atrial fibrillation patients with heart failure receiving cardiac resynchronization therapy. Atrioventricular node ablation and biventricular pacing could turn out to be the superior non-pharmacological method of atrial fibrillation rate control.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 9/F, Clinical Sciences Building, Shatin, N.T., Hong Kong

    Joseph Yat-Sun Chan FRCP & Cheuk-Man Yu MD, MBChB, FRCP, FRACP, FACC

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  1. Joseph Yat-Sun Chan FRCP
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  2. Cheuk-Man Yu MD, MBChB, FRCP, FRACP, FACC
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Correspondence to Cheuk-Man Yu MD, MBChB, FRCP, FRACP, FACC .

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Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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Chan, J.YS., Yu, CM. (2014). Pacemaker Dependence After Atrioventricular Node Ablation. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_46

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