Turk Kardiyol Dern Ars. Ahead of Print: TKDA-13766 | DOI: 10.5543/tkda.2019.13766
Permanent his bundle pacing and atrioventricular node ablation in a case with drug refractory atrial fibrillation
, Emre Erturk
, Caner Topaloğlu
, Mohammed Abusharekh
Department Of Cardiology, Medical Park Hospital, Izmir, Turkey
Permanent His bundle pacing (HBP) has become an advantageous method in patients with high degree ventricular pacing by activating the ventricles through normal conduction system. We present a case with drug refractory atrial fibrillation with high ventricular rate that was treated with AV node ablation and permanent HBP.
A 62-year-old woman with persistent AF and drug refractory high ventricular rate response was referred for exercise intolerance and palpitation. She had history of failed catheter ablation attempts and amiodarone toxicity for rhythm control. Permanent HBP and AV node ablation was planned in a stepwise approach for rate control. Initially permanent pacemaker implantation was performed. His lead and right ventricular back up leads were implanted successfully as described previously. His lead was connected to the atrial channel of pacemaker battery and programmed to AAI pacing mode. AV node was ablated successfully 3 weeks later without any threshold changes in His lead. We did not observe any His lead threshold changes during or after AV node ablation in our case and patient was asymptomatic with twice daily apixaban 5 mg.
Permanent HBP after AV node ablation can be a reasonable treatment option to prevent pacing induced ventricular dyssynchrony and heart failure in patients who are not eligible for cardiac resynchronization therapy.
His, pacing, ablation, AV Node, Refractory AF, AF
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Corresponding Author: Emre Erturk, Türkiye