113
Uncontrolled rate with
biventricular pacemaker
in place without effective
pacing %:
AV Nodal ablation
(2a)
HFrEF (LVEF ≤50%)
Uncontrolled rate + rhythm
control failed or not
appropriate:
AV nodal ablation + pacing
(2a)
Left bundle or His bundle
pacing (HBP) as alternative
to biventricular pacing
(2b)
Repeat
ablation
Decision for
pharmacological rhythm-
vs. rate-control strategy
Pharmacological
cardioversion and
maintenance of sinus
rhythm after cardioversion
(See sections 8.2.3
and 8.3.1)
Less likely to benefit from
catheter ablation
• Advanced HF
• Significant ventricular scar
on CMR
• Severe atrial myopathy
(dilation/fibrosis)
• Long-standing persistent AF
• Prior failed ablations
• Advanced age or multiple
comorbidities
Dronaderone
NYHA Class III/IV HF
or decompensated
HF in past 4 wk
(3: Harm)
