Impact of atrioventricular node ablation and permanent pacing on clinical outcomes, quality of life, and health care utilization in patients with atrial fibrillation

Background: Atrioventricular node ablation (AVNA) is a class IIa, level B recommendation in the international atrial fibrillation (AF) guidelines.While its impact on symptoms is known, effects on healthcare utilization and quality of life (QoL) remain unclear.Conduction system pacing, particularly left bundle branch pacing (LBBP), may further optimize these outcomes.Objective: To assess the impact of AVNA on clinical outcomes, QoL, and healthcare utilization.Methods: Data from patients who underwent AVNA between 2019 and 2024 at a Dutch tertiary referral center were analyzed.Patients received right ventricular, biventricular, or LBBP.Outcomes included [1] clinical outcomes, [2] SF-36 QoL scores at baseline and one-year follow-up, and [3] healthcare utilization per patient-year one year prior up to one year after AVNA.Results: Of 248 patients (median age 77 years, 44.4% male), most received LBBP (62.5%), followed by biventricular (19.8%) and RV pacing (17.7%).Procedural complications were minimal (0.8%).90days mortality was 4.0% (n = 10) and one-year mortality was 10.5% (n = 26), and deaths were related to heart failure (46.2%) or non-cardiac causes (53.8%).QoL improved in 67.0% and deteriorated in 14.4%.Post-AVNA, healthcare utilization decreased significantly across all domains: outpatient clinic visits (-27.5%)emergency department visits (-72.1%),Holter analyses (-84.2%),electrocardiograms (-52.5%),ECVs (-98.2%),additional AF ablations (-83.3%), and PM/ICD upgrades (-81.8%;all p <.001). Conclusion:AVNA is a safe intervention associated with a significant reduction in healthcare utilization and improved QoL.These findings support AVNA as a valuable strategy for managing AF in an increasingly resource-constrained healthcare environment.