Assessment of left ventricular pacing in patients with severe cardiac failure after atrioventricular node ablation and right ventricular pacing for permanent atrial fibrillation

In patients with functionally poorly tolerated permanent atrial fibrillation (AF) radiofrequency (RF) catheter ablation of the atrioventricular (AV) node is considered a potential treatment. However, the treatment is established in patients with haemodynamically deleterious AF despite optimal medical therapy. After this procedure, permanent ventricular pacing is mandatory with an electrode implanted in the right ventricular apex. However, in some patients, restoration of a lower and regular ventricular rhythm does not improve symptoms of cardiac failure, and in some patients the haemodynamic status deteriorates. Finally, in some others after a period of well-being symptoms of severe cardiac failure recur. In these cases, therapeutic options are very limited: modifications in medical treatment have usually already been shown to be ineffective. Cardiac transplantation is very restricted in patients older than 60 years due to the shortage of donor hearts and other options are unrealistic either because they are experimental or ineffective. Recently, left ventricular pacing has been shown to be effective in improving the functional status of patients with end-stage cardiac failure. The aim of the present study was to evaluate the preliminary results of this procedure in patients with severe cardiac failure after AV node ablation for permanent AF.