Radiofrequency ablation of the AV conduction tissue (His-bundle ablation) is an accepted treatment for therapy resistant atrial fibrillation/flutter. However, data on the long-term effects of the procedure are limited. We followed 50 patients for a mean of 17 months after AV junction ablation. The indication was treatment resistant atrial fibrillation or flutter. The patients underwent a standardized interview performed by two nurses. Health care was studied via the in-patient register. Subjective improvement was reported by 88% and the number of days in hospital per year was reduced from 17 to 7. The use of antiarrhythmic drugs was reduced by 75%. If the reduction in costs of drugs and days in hospital is compared with the cost of the ablation and the pacemaker implantation, breaking even is achieved after 2.6 years. We could not confirm that patients with paroxysmal atrial fibrillation note less improvement than those with chronic fibrillation.
Conclusion: Ablation of the AV junction is a cost effective treatment with good long-term results and relatively few complications.
Recommendations: Chronic atrial fibrillation: If sinus rhythm cannot be established and in cases in which heart rate regulating drugs have been ineffective, ablation of the AV junction with implantation of a VVIR pacemaker is recommended.
Paroxysmal atrial fibrillation: If the patient despite treatment with antiarrhythmic drugs continues to have symptomatic episodes of atrial fibrillation, then AV junction ablation with implantation of a permanent pacemaker is recommended. Patients who have self-limiting episodes of atrial fibrillation should be given a DDDR pacemaker with an automatic mode switch. Patients who do not have self-limiting attacks and require DC conversion, should receive a VVIR pacemaker.