Question 28#

An 80-year-old woman with permanent atrial fibrillation and palpitations attends clinic. She has been in AF for over 10 years and has a left atrial diameter of 5.5 cm. She has high ventricular rates despite being on digoxin 125 micrograms od and atenolol 50 mg od. She has dizzy episodes when she has high ventricular rates and had a pre-syncopal episode 1 month ago. She is keen to consider an AV node ablation.
What do you advise?

A) There is no evidence that this will improve her symptoms
B) The mortality of the procedure is about the same as for medical treatment of AF
C) The procedure is contraindicated in patients with heart failure
D) PVI ablation should be attempted first
E) A pacemaker is required but will be programmed to minimize right heart pacing

Correct Answer is B


There is evidence that AV node ablation improves exercise tolerance, LVEF, and quality of life. The overall mortality of the procedure at 1 year (6%) is similar to that of antiarrhythmic therapy for AF. AV node ablation with a CRT implant in those with AF and heart failure has been shown to improve LVEF. PVI is not a first-line treatment for AF. The patient will require 100% ventricular pacing