Atrioventricular Junction Ablation with High-Definition Recording of Atrioventricular Node Potential

Atrioventricular (AV) node ablation represents an established therapeutic option in the management of atrial fibrillation (AF) and other atrial tachyarrhythmias, particularly in patients with symptomatic tachycardia who remain unresponsive or intolerant to pharmacological therapy. The procedure is often considered in cases of refractory arrhythmias, antiarrhythmic drugs intolerance, or tachycardiomyopathy, and plays a key role in optimizing outcomes in patients undergoing cardiac resynchronization therapy, where achieving adequate biventricular pacing is otherwise compromised by rapid ventricular responses. Traditionally, AV node ablation is performed using radiofrequency energy delivered at the region of the His bundle, guided by the earliest His potential recordings. However, the anatomical complexity of the AV node and Koch's triangle poses important challenges, including the risk of incomplete ablation, persistence of conduction, lack of reliable junctional escape rhythms, and increased risk of proarrhythmia. Recent advances in high-resolution mapping and electroanatomical guidance have enabled a more precise anatomical approach, selectively targeting the compact AV node while reducing collateral injury. These developments offer the potential for improved procedural safety, long-term efficacy, and a more standardized strategy for patient management. This review summarizes current evidence, techniques, and clinical implications of AV node ablation, highlighting its role in the evolving landscape of arrhythmia treatment.