69 years old man implanted with a triple chamber defibrillator Viva XT CRT-D for valvular cardiomyopathy with permanent AF (No atrial lead implanted) and a narrow QRS; device interrogation performed a few hours after the implant;
The patient underwent a His bundle ablation; device interrogation the day after the ablation procedure;
Two different types of AF patients benefit form a resynchronization therapy: 1) patients with slow AF and a bundle branch block 2) AF patients with a rapid ventricular response and a narrow or wide QRS. In the latter type of patients, the rate control is essential once the patient resynchronized. This rate control can be achieved by using rate control medications. However the results is often imperfect. The ablation of the His bundle is often necessary to enable the high percentages of biventricular stimulation essential to the success of this therapy. His ablation is now part of the recommendations of the international guidelines for the treatment of patients with chronic AF and poorly controlled heart rate. After the ablation of the His bundle, a rate responsive function must be programmed.
