Pacemaker and AV node ablation after multiple AF ablation procedures: a patients perspective - The PANAMA PAPER

Abstract Funding Acknowledgements Type of funding sources: None. Objectives The aim of this study was to assess the number of AF catheter ablations appropriate before decision of pacemaker implantation and AV node ablation. Background The main purpose of AF treatment strategy, including both therapies aimed to maintain sinus rhythm and therapies that control the rate, is symptomatic improvement. Complex decision-making is involved in the choice of strategy. Indication for AF catheter ablation is the presence of symptomatic paroxysmal or persistent AF. However, many patients suffer from arrhythmia recurrence. Atrioventricular (AV) node ablation is a therapeutic option when AF is refractory to other therapeutic options. Methods This is a retrospective study based on patients recruited from the local database at Haukeland university hospital. Criteria for inclusion were patients with highly symptomatic AF after two or more AF catheter ablations and finally pacemaker and AV node ablation. Symptomatic improvement and quality of life were assessed using modified European Heart Rhythm Association (mEHRA) classification and self-evaluation. Results A total 23 patients were included in the study. After repeated AF catheter ablations, 7 (30.4%) patients had improvement in mEHRA class, most often by one class (n = 6). The improvement after AV node ablation were more significant (6 patients by 1 mEHRA class, 7 by 2, 5 by 3). According to the self-evaluation after AV node ablation, 18 patients were satisfied with respect to quality of life. The number of hospitalization were reduced from more than 6 per year (n = 11) to zero (n = 17) per year. Only one patient, among the 12 with only two AF catheter ablations, would prefer further attempts at AF catheter ablation. Retrospectively, 7 out 11 patients with at least 3 AF catheter ablations had preferred earlier pacemaker implantation and AV node ablation. Conclusion AV node ablation after several AF catheter ablations is a good option according to patients experience. In selected groups, recognized to have lower clinical efficacy of pulmonary vein isolation, AV node ablation might be considered after 2 or 3 unsuccessful AF catheter ablations.