Permanent His bundle pacing and atrioventricular node ablation for rate control in permanent atrial fibrillation. A case report

Atrial fibrillation (AF) is a serious cause of morbidity and mortality in the general population, with an increasing prevalence with the improvement in diagnosis. The best current treatment approach is catheter ablation (mainly isolation of the pulmonary veins), but this is ineffective in permanent atrial fi brillation. Rate control is frequently mandatory in these patients and the most effective technique is atrioventricular node ablation. But, since this procedure renders the patient pacemaker dependent, one should be very cautious with the pacing mode selected for long-term pacing. We present the case of a 45 year-old male with permanent atrial fi brillation and drug-refractory rapid ventricular rate and tachycardia-induced cardiomyopathy, who underwent catheter ablation of the atrioventricular node and permanent selective His bundle pacing. Following the procedure, the patient went from a rapid, irregular rhythm to a controlled, regular rhythm without a change in QRS morphology. The follow-up after three months showed near complete recovery of the left ventricle and the disappearance of heart failure symptoms.