Background

Ablation of the atrioventricular node (AVN) is an important therapeutic option for patients with atrial fibrillation (AF) or atrial tachycardia (AT) in whom rhythm control and pharmacological rate control have failed. However, data is sparse on long-term outcome of patients with previously failed interventional rhythm control undergoing AVN ablation.

Aims

The present study analyzes safety and efficacy of AVN ablation of patients with symptomatic AF or AT after previous attempts of catheter ablation.

Methods

In this observational study patients were analyzed who underwent AVN ablation after failed rhythm control attempts by catheter ablation of AF or AT between 04/2014 and 02/2022 at our institution. Clinical data and follow-up data including cardiac device interrogation was collected and analyzed regarding safety and efficacy of AVN ablation. A combined safety endpoint consisting of lead revision, device infection or upgrade for cardiac resynchronization therapy was analyzed.

Results

Fifty-three patients (30 female (56.6%), mean age 71.0±9.2 years) were included into the study. A mean of 2.1±1.2 catheter ablation procedures aiming at rhythm control preceding AVN ablation were conducted. Patients suffered from paroxysmal AF in 1 case (1.9%), persistent AF in 43 cases (81.1%) and atrial tachycardia in 36 cases (62.3%). AVN ablation was successful in all patients. No complications occurred during AVN ablation. Mean follow-up duration was 629.2±99.8 days in 43 patients with available follow-up data. Persistent complete AV block was present in all but one patient (42/43 patients with follow-up, 97.7%). Sufficient rate control was achieved in all patients. No rapid AV conduction of AF or organized AT was documented. The composite safety endpoint occurred in 2 patients (4.7%) with 2 cases of CRT upgrade. No cases of lead revision or device infection occurred.

Conclusion

AVN ablation is effective and safe in patients with failed catheter ablation for rhythm control. Rate control was sufficient and no programming issues occurred, even in patients with organized tachycardias.