C. Menozzi et al., RADIOFREQUENCY CATHETER ABLATION AND MODULATION OF ATRIOVENTRICULAR-CONDUCTION IN PATIENTS WITH ATRIAL-FIBRILLATION, PACE, 17(11), 1994, pp. 2143-2149
We attempted radiofrequency ablation of the AV junction with a sequent
ial right- and left-sided approach in 78 patients affected by severely
symptomatic, drug refractory atrial fibrillation. Stable third-degree
AV block was obtained in 99% of cases and, after 3 months, persisted
in 92% of cases. single session, stepwise, radiofrequency modulation o
f the AV node was attempted in 13 patients with paroxysmal atrial fibr
illation. During sinus rhythm, ablation of the slow; and fast AV node
pathways was performed in order to increase the nodal refractory perio
d or to slow conduction. Clinically successful modulation of Av conduc
tion was achieved in 15% of cases and persisted during a 3-month follo
w-up. In conclusion, AV junction ablation is a well-established means
of treating atrial fibrillation, but implies the implant of a permanen
t pacemaker. AV node modulation avoids the pacemaker implant, but is e
fficacious only in a minority of patients. Thus, in patients affected
by paroxysmal atrial fibrillation, AV modulation should be attempted f
irst; if this is ineffective, AV ablation can be performed during the
same session.