Acute and long-term outcomes of left-sided atrioventricular node ablation in patients with atrial fibrillation

A randomized comparison of retrograde left‐sided versus anterograde right‐sided ablation of the atrioventricular junction

“…In addition, there was no long‐term recovery of the AV node conduction. Similar to our study, the median number of RF applications for left‐sided ablation was 2 and the mean procedure time was 28.4 ± 2.4 minutes less than that previously reported for right‐sided ablation 9 . Although the success rate of left‐sided ablation reported by Yorgun et al was higher than the reported success rate reported in this study, Yorgun et al only report the outcomes of those undergoing left‐sided ablation and thus there may be selection bias accounting for their results 9 …”

“…There may have been a failure of complete deployment in a few cases, although all operators in our study were very experienced in angioseal deployment. Additionally, Yorgun et al 9 stopped novel anticoagulants 24 hours before the procedure, whereas in our study, anticoagulation was continued until the morning of the procedure, increasing the potential for bleeding and hematomas.…”

“…Traditionally this has been performed with a right‐sided approach with success rates of more than 95%. However, in some cases, right‐sided ablation is challenging and leads to procedural failure, with cross‐over to the left‐sided retrograde technique or a repeat procedure 6,9,10 . In studies performing left‐sided ablation, it has been shown that atrioventricular conduction block can be induced by a lesser number of RF applications resulting in decreased procedure times and fluoroscopy times.…”

“…Its proximity to the left‐sided endocardium has been shown in cases in which inadvertent atrioventricular block has been induced while ablating other left‐sided arrhythmias 7,11,12 . Thus, performing an initial left‐sided atrioventricular ablation has been proposed as an alternative to the right‐sided approach to reduce procedure time, fluoroscopy time, and also reduce the risk associated with pacemaker lead injury or displacement 9 …”

Acute echocardiographic and electrocardiographic effects of triggered left ventricular pacing

“…A high BiV pacing rate might be achieved by pharmacological treatments like beta-blockers, digitalis or amiodarone [28]. Furthermore, electrophysiological procedures such as pulmonary vein isolation, atrioventricular junction ablation (AVJA) and ablation of atrial and ventricular tachycardia or ectopic beats are well-established strategies to ensure a high BiV pacing rate [29][30][31][32][33][34]. In addition, CRT device manufacturer designed algorithms to ensure BiV pacing, which however increases battery consumption and their effect on clinical outcome has not been proven yet.…”