What is AV node ablation?

This is an infrequently used treatment for atrial fibrillation. During this procedure, catheters are inserted into the veins in the groin and guided toward the heart. Radiofrequency energy travels through the catheters to damage the AV node, which connects the heart’s upper and lower chambers. As a result, the heart rate slows. Patients who undergo this procedure require a permanent pacemaker and anticoagulant medications.

Some patients who have severe atrial fibrillation (AF) symptoms do not respond to medications and may be helped by a procedure called AV nodal ablation, which creates a complete interruption or block of the electrical pathway between the upper (atrial) and lower (ventricular) chambers of the heart.

During this specialty electrophysiologic procedure, a special catheter is threaded through a vein to the heart. It is positioned at the AV node area. Then energy, either hot or cold, is delivered through the tip of this catheter to prevent AF from traveling from the atria to the ventricles. Most often, the energy is heat from a radiofrequency energy generator. The result is heart block and a slow heart rate, so a pacemaker is needed to provide an adequate heart rate. Patients who are in AF all the time receive a single lead (ventricular) pacemaker. Patients who are in and out of AF with regular rhythm in between the episodes will benefit most from a pacemaker that has two leads (one in the right atrium and another in the right ventricle). Other types of pacemakers may be used if you have other needs. Your doctor will talk to you about these needs and devices if necessary. This procedure causes a lifelong need for a pacemaker.

Progress in pacemaker design improves quality of life because it results in fewer symptoms.