Endocardial transcatheter stimulation of the AV nodal fat pad: stabilization of rapid ventricular rate response during atrial fibrillation in left ventricular failure.

INTRODUCTION

Recent acute studies demonstrated that atrioventricular (AV) node vagal stimulation during atrial fibrillation (AF) decreases the mean ventricular rate, thus improving hemodynamics.

METHODS AND

RESULTS

We report a case of a woman with acute heart failure (HF), chronic AF with untreatable ventricular rapid response, in severe hypotensive state due to a cardiogenic shock. The patient underwent left ventricular (LV) pacemaker implantation and received 50 Hz AV node stimulation, delivered through a posteroseptal atrial lead, thus allowing a 100% pacing. Hemodynamics improvements allowed carvedilol titration; the rate was below 85 bpm after 4 days, then the atrial lead was removed.

CONCLUSIONS

This novel strategy may allow controlling the rapid AV response in patients undergoing pacemaker implantation.