Intersection of EP and HF: Pacing Paradigms and Conduction System Pacing in AF with HF: Who, When, and How?-AF with HF: Who, When, and Why Video

Video Transcription

Video Summary

The speaker explains the strong link between atrial fibrillation (AF) and heart failure, noting that occult heart failure is very common in AF, especially in persistent AF. He reviews why AF worsens heart function: loss of AV synchrony, rapid and irregular ventricular rates, reduced cardiac output, impaired calcium handling, poorer coronary perfusion, and adverse remodeling. Regular pacing can improve hemodynamics by eliminating “irregulopathy,” and AV node ablation plus pacing (“pace and ablate”) can be especially effective. Evidence shows benefits in quality of life, and in some studies CRT with AV junction ablation reduced heart failure events and mortality. Newer conduction system pacing appears comparable to biventricular pacing in improving ejection fraction. The speaker concludes that restoring sinus rhythm with AF ablation is ideal when possible, but pace-and-ablate should be viewed as a legitimate strategy for patients unlikely to maintain sinus rhythm.

Keywords

atrial fibrillation

heart failure

AV node ablation

pacing therapy

sinus rhythm restoration