Atrioventricular Nodal Ablation and Pacing in Refractory Atrial Fibrillation and Heart Failure.

Atrioventricular nodal ablation (AVNA) represents a critical intervention in the management of refractory atrial fibrillation (AF) and heart failure (HF). When combined with biventricular pacing or conduction system pacing, particularly His bundle pacing and left bundle branch area pacing, this strategy offers distinct and complementary benefits. While each pacing modality presents unique advantages and potential limitations, their combination with AVNA offers a comprehensive and individualized treatment strategy for addressing associated HF. This integrated approach can enhance symptom control, improve hemodynamic performance, and contribute to better long-term outcomes in patients with advanced HF and AF.