Left and Right Approach Atrioventricular Junctional Ablation in Patients With Permanent Atrial Fibrillation


Department of Cardiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, I.R.Iran.


Background: Despite the clear beneficial effects of atrioventricular nodal ablation (AVNA) in atrial fibrillation (AF), the differences in these effects between the 2 technical methods of AVNA—retrograde and antegrade approaches—remain unclear. The present study aimed to compare the outcome of these 2 AVNA approaches in AF. Methods: This clinical trial was performed on 109 consecutive patients candidated for cardiac resynchronization therapy (CRT) due to the presence of simultaneous heart failure and AF. The eligible patients were randomly scheduled for CRT via left AVNA or CRT via right AVNA or medical treatment approaches. Results: No statistically significant differences were observed between the right (3.12–1.88) and left (3.12–1.78) approaches of AVNA regarding a decrease in New York Heart Association score as well as an increase in left ventricular ejection fraction (18.0%–23.75% in the right approach and 18.46%–25.77% in the left approach). Although the severity of mitral regurgitation significantly decreased following both CRT via the left AVNA approach and CRT via the right AVNA approach, the reduction in the severity of mitral regurgitation was more prominent in those treated by CRT via the right AVNA approach. Conclusions: In reducing the severity of mitral regurgitation as well as femoral complications, right AVNA was superior to left AVNA, while left AVNA was preferable to right AVNA concerning the escape rate, procedure time, and radiofrequency rate.