Unsuccessful AV nodal ablation in atrial fibrillation: an alternative method to achieve complete heart block.

We report the case of an elderly patient who presented with poorly tolerated episodes of atrial arrhythmia refractory to medical treatment. AV node ablation was identified as the only alternative expected to be efficacious for symptom relief. However, this usually simple intervention failed. The goal of creating a complete AV block was finally achieved through ablation of the anterior fascicle of the His bundle, which represented the only pathway for residual conduction in this patient.