Prevention

• ablation of AV node and insertion of a DDDR permanent pacemaker ^a  

Why?

• Ablation and pacemaker insertion compared with drug therapy reduces symptoms, hospital admissions or need for DC cardioversion. ^a
• However more patients go into permanent atrial fibrillation. ^a
• Patients have fewer symptoms with AV junction ablation rather than AV junction modification ^a

Resistant paroxysmal AF: AV node ablation and pacemaker insertion improves symptoms

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
intolerable paroxysmal AF resistant to anti-arrhythmic medication a	AV node ablation and insertion of pacemaker	drug therapy	permanent AF at 6 months	0%	87% (27% to 100%)	-4 (-18 to -2)
			subjective perception of AF tachyarrhythmia at 6 months	89%	79% (47% to 91%)	1 (1 to 2)
			hospitalisation or DC cardioversion at 6 months	33%	86% (-8% to 98%)	4 (2 to 20)