It is known that conversion of atrial fibrillation to sinus rhythm does not improve survival. The reason for trying to maintain sinus rhythm is mainly to control symptoms. Neither antiarrhythmic drugs nor atrial pacing alone have been successful in suppressing atrial fibrillation.
A. Atrial Pacing
Recently, dual-site right atrial pacing has been shown in small studies to achieve partial suppression of arrhythmia in patients with bradycardia and atrial fibrillation on antiarrhythmic drugs. The trials, however, do not support the use of atrial pacing as monotherapy in symptomatic atrial fibrillation.
B. Ablation of the AV node and Implantation of a Permanent Pacemaker
This procedure is a last resort for patients with bothersome atrial fibrillation refractory to other treatments. The ablation of the AV node produces rate control and regular ventricular contractions, but the atria continue to fibrillate and the risk of stroke remains. Mortality is not improved by this procedure. The combined incidence rate of sudden death and malignant ventricular arrhythmias is approxi¬mately 7%.
1. Clinical Study, Ozcan et al.
In a study of 334 consecutive patients with atrial fibrillation who underwent AV node ablation, 9 patients had sudden death after the ablation, 4 patients had sudden death likely related to the procedure, and in 3 patients arrest occurred within 48 h and 1 patient arrested 4 days after the procedure. In three other patients sudden death was possibly related to the procedure, because the event occurred within 3 months afterward.

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