OasisLMS

In this webinar, Dr. Kenneth Ellenbogen explores how atrial fibrillation intersects with heart failure and when a pace-and-ablate strategy makes sense. Drawing on invasive hemodynamic studies, the speaker shows how common occult heart failure is in patients with AF, especially persistent AF. The talk walks through the mechanisms by which an irregular heart rate harms cardiac function, including reduced cardiac output, impaired calcium handling, decreased coronary perfusion, and worsening mitral regurgitation. The speaker then reviews clinical trial evidence for AV node ablation with RV, biventricular, and conduction system pacing, compares outcomes with catheter ablation, and highlights ongoing trials. The session closes with the case that, in the era of conduction system pacing, pace and ablate should no longer be viewed only as a bailout procedure.

Made possible with support from Medtronic

• Recognize the high prevalence of occult heart failure in patients with paroxysmal and persistent atrial fibrillation.
• Describe the mechanisms by which an irregular heart rate reduces cardiac function, including effects on stroke volume, calcium handling, and coronary perfusion.
• Summarize the clinical trial evidence for AV node ablation combined with RV, biventricular, or conduction system pacing.
• Compare the outcomes of pace and ablate versus catheter ablation in patients with AF and heart failure.
• Identify patients who may benefit from pace and ablate as an earlier treatment option rather than a bailout procedure.

Presenter

Kenneth Ellenbogen, MD, FHRS
Virginia Commonwealth University Medical Center | Kimmerling Professor of Cardiology