Report of a study group on ablate and pace therapy for paroxysmal atrial fibrillation

Atrioventricular junctional (AVJ) catheter ablation followed by pacemaker i mplantation is now widely accepted for patients affected by paroxysmal atri al fibrillation (PAF) not controlled by antiarrhythmic drugs. however, few data exist on its indications, optimal methodology and complications. There fore a study group examined current practice in Eur ope and North America, using a questionnaire. followed by a Study Group Meeting to discuss the res ults. Based upon this, class I, class II and class III indications were pro posed. Class I indications (for which general agreement existed) include dr ug-refractory PAF, correlating with important symptoms. the bradycardia-tac hycardia syndrome already treated with a pacemaker, and continued PAF. Larg e differences exist in the current methodology, but consensus was reached o n the technical approaches of right and left-sided AVJ ablation, and on the timing of pacemaker implant in relation to ablation. No complete agreement was reached on technical features such as catheter choice and heparin use. The recommended pacing mode was DDDR with mode switching.