AV node ablation

The present chapter will review clinical trials of atrial pacing for prevention of AF, trials of specific atrial pacing algorithms for prevention of AF, studies of selected atrial pacing sites for prevention of AF and pacing modalities to be considered following AV node ablation. 

Supraventricular tachycardia 35 5 Program additional detection criteria (sudden onset, morphology) Consider therapy for supraventricular arrhythmias (tachycardia, drugs, or AV node ablation for atrial fibrillation) Consider implantation of an atrial lead. 

In a VVIR mode double counting each R wave could theoretically occur when the sensor indicated pacing rate is surpassed by ventricular conduction. Therefore, it is extremely important to perform all maneuvers that minimize the likelihood of losing ventricular capture over the expected range of normal heart rates. Again, this includes the use of drugs to control the native ventricular response in AF, and potentially the use of AV node ablation when drugs fail to accomplish the desired effect. 

You are called regarding a colleague s 73-year-old female patient who underwent insertion of an ICD for VT as well as AV node ablation secondary to paroxysmal AF with rapid ventricular response that was refractory to medical management. Apparently, upon arriving on the floor from the recovery room she had complaints of lightheadedness and received multiple shocks from the ICD. You obtained this strip that was representative of the events leading to each of the shocks. 

Rodriguez LM, Leunissen J, Hoekstra A et at. (1998) Transvenous cold mapping and cryoablation of the AV node in dogs observations of chronic lesions and comparison to those obtained using radiofrequency ablation. J Cardiovasc Electrophysiol 9 1055-1061... 

Although it has not been extensively studied at present, some patients with chronic AF may receive CRT ICD devices. In these patients the mode is preferably VVIR. Again, since the goal is to pace the ventricles 100% of the time, native conduction to the ventricles in AF needs to be prevented. This is accomplished by providing an adequate lower and upper rate, and utilizing adjunctive AV nodal blocking medicines when needed. In more extreme circumstances the AV node may need to be ablated when medical management cannot control a rapid ventricular response in AF. 

Management Solution Consider increasing AV node blocking drugs vs. curative catheter ablation (this patient underwent successful ablation of the AV node slow pathway). 

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