post av nodal ablation evaluation (PAVE) trial The Question Atrial fibrillation (AF) is the most common type of abnormal heart rhythm. One treatment strategy for AF is referred to as “ablate and pace.” Ablation is based on the idea that by destroying abnormal tissue in the heart (the atrioventricular node in this case), the electrical system can be repaired and the heart will return to normal rhythm. Repairing the electrical system involves implanting a pacemaker. The standard has been to place a right ventricular pacemaker. Is biventricular (both right and left ventricles) pacing more effective than right ventricular pacing? This Study PAVE is the first large study to evaluate biventricular pacing (BVP) after ablate and pace therapy in patients with chronic AF. BVP was compared with right ventricular pacing (RVP) in 184 patients who had chronic AF for at least one month, had mild to moderate heart failure, and were not able to walk at least 450 meters during a six -minute walk test. Followed for six months, patients were evaluated based on a walk test, oxygen intake, exercise duration and quality-of-life score. At six months, BVP patients experienced improvements in cardiac function as demonstrated in six-minute walk time, increasing 82 meters, compared with 56 meters in RVP patients. BVP patients also demonstrated improved functional capacity as demonstrated by improved oxygen intake and improved exercise duration; whereas RVP patients did not improve. Quality-of-life measurements also indicated improvement for BVP patients. Conclusion Biventricular pacing is superior to right ventricular pacing in atrial fibrillation patients treated with ablate and pace therapy. Who may be affected by these findings? Atrial fibrillation affects about 2 million Americans. Currently an estimated 37,000 patients with chronic AF undergo ablate and pace procedures each year. That number is expected to grow 18% annually, with an estimated 63,000 procedures performed annually by 2006. Caveats Limited patient follow-up in this study may prompt questions related to the long-term effectiveness of biventricular pacing. Additionally, with the small patient population, it is not known what the risks and benefits of BVP are in a broad group of patients. The study may prompt another question: should we continue to pace the right ventricle at all? Find this Study http://www.medscape.com/viewarticle/471491 Sponsor and Presentation St. Jude Medical. Presented at the American College of Cardiology Scientific Sessions in March of 2004.