After atrioventricular node ablation the patient is pacemaker dependent, and a sudden fall from a fast ventricular rate to a slow paced rate has been linked to ventricular arrhythmia and sudden death early on. The usual practice is to programme a higher lower rate, commonly around 80 to 90 beats per minute, for the first weeks and then reduce it gradually.
Check pacing thresholds and lead stability before discharge, because there is no escape rhythm to fall back on, and make sure the patient knows they are now device dependent.
- Programme a higher lower rate for the first weeks after ablation, then step it down at follow-up.
- Confirm stable capture thresholds before discharge: these patients have no reliable escape rhythm.
- Tell the patient and their GP that the patient is pacemaker dependent.
- Continue anticoagulation according to stroke risk; ablation of the node does not treat the atrial fibrillation.
Why it matters
The early weeks after ablation carry a specific, preventable arrhythmic risk that programming addresses.
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