Sudden death from polymorphic ventricular tachycardia is a recognised early risk after atrioventricular node ablation, linked to the abrupt fall in heart rate and the repolarisation changes that follow. The established approach is to programme the lower pacing rate at about 80–90 beats per minute for the first one to two months, then reduce it gradually at follow-up.
This applies whatever pacing strategy is chosen, including conduction system pacing. Check that the follow-up appointment to lower the rate is booked before discharge, and correct potassium and magnesium and review QT-prolonging drugs in the meantime.
- Programme a lower rate of about 80–90 bpm for the first one to two months after AV node ablation
- Book the visit to step the rate down before the patient leaves
- Correct potassium and magnesium and review QT-prolonging drugs early after ablation
- Confirm the pacing threshold is stable, since the patient is now pacemaker-dependent
Why it matters
The patient is fully pacing-dependent from the moment the ablation is done, and the early weeks carry the highest arrhythmic risk.
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