What is the role of AV node ablation in treatment of atrial fibrillation?
Radiofrequency ablation should be considered in patients with a rapid ventricular rate in whom medical therapy is poorly tolerated or unsuccessful, or both. The procedure involves ablation of the compact AV node and insertion of either a single-chamber pacemaker (in chronic AF) or a dual-chamber pacemaker (in paroxysmal AF). The procedure is virtually 100% successful, and late recurrence of AV nodal conduction is rare. In addition to controlling the ventricular rate, ablation may eliminate or reduce the need for medication, improve symptom control, enhance myocardial function, and reduce the number of hospital admissions. However, Radiofrequency ablation also has several potential downsides, including the need for pacing and the risk of procedure-related complications. In addition, anticoagulation therapy is still necessary in the majority of patients, and in those with paroxysmal AF, the need for antiarrhythmic medication may or may not be obviated.