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This editorial refers to ‘Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial’[†][1], by M. Brignole et al. , on page 2420 State of the art treatment of atrial fibrillation in an individual patient may follow different, complex avenues depending on symptoms, clinical circumstances, and patient preferences. Management may become particularly challenging when atrial fibrillation is associated with other co-morbidities, especially heart failure. Epidemiological studies have shown that heart failure with New York Heart Association (NYHA) functional class II–IV may be complicated by atrial fibrillation in up to 50% of cases, and this association carries a worse prognosis.1 In these cases, while ventricular rate control may be the first objective based on results of large, multicentre studies,2 adequate doses of vasoactive medications may not be tolerated and antiarrhythmic medications or ablation to help with rhythm control may be contraindicated or ineffective. In these challenging cases, atrioventricular (AV) junction ablation and cardiac pacing is an alternative treatment option. AV junction ablation, by slowing and regularizing the ventricular rate, has been shown to improve symptoms, quality of life, and cardiac function, as judged by both physiological and structural measurements.3 It … [1]: #fn-2

Role of cardiac resynchronization therapy and atrioventricular junction ablation in patients with permanent atrial fibrillation