Atrio-ventricular nodal ablation with biventricular pacing in atrial fibrillation with narrow QRS – a novel strategy to reduce mortality independent of underling left ventricular function.

Historically, clinical studies have demonstrated conflicting results for rate-control versus rhythm-control strategy in patients with permanent atrial fibrillation (AF) in terms of long-term mortality and morbidity. The concept of atrioventricular (AV) nodal ablation coupled with permanent biventricular pacing has recently been advocated as the closest approach to obtain a physiological reset especially in AF patients having underlying ventricular dysfunction. Herein, we present a critical analysis and detailed review based on prior and currently available evidence based on the ablation in permanent atrial fibrillation – cardiac resynchronization therapy (APAF-CRT) mortality trial.