Abstract
Atrioventricular (AV) junction ablation (AVJA) is an acceptable strategy to control the heart rate in atrial fibrillation (AF) with a high procedural success rate. However, a small subset of patients pose a technical challenge with the standard right-sided approach. High-output His-bundle pacing has been shown to help localize the His bundle in a difficult-to-ablate AV junction. We report a case series of patients with difficult-to-ablate AVJA and present strategies to troubleshoot them. In this small series of patients, we found that high-output His pacing can be an effective alternative for successfully localizing the AVJA site. In this series, we also observed that an inability to achieve His capture from the right side can predict failure of ablation using the standard right-sided approach and the consequent need for a left-sided approach.
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