AV node ablation

AV (atrioventricular) node ablation is a cardiac catheterization procedure to treat atrial fibrillation. Your doctor applies radiofrequency energy (heat) to the pathway connecting the upper chambers (atria) and lower chambers (ventricles) of your heart (AV node) through a catheter. This destroys a small area of tissue, which prevents the atria from sending faulty electrical impulses to the ventricles.

The faulty impulses are still generated, so the atria continues to quiver (fibrillate). But signals are prevented from reaching the ventricles.

After AV node ablation, your symptoms will likely improve, and you won't need to take drugs to control your heart rate. But you may need to take blood-thinning medications to reduce the risk of stroke. A permanent pacemaker is implanted to make the bottom chamber contract with a normal rate.

Why it's done

AV node ablation is done to safely correct the heart rate and ease symptoms of people with atrial fibrillation that hasn't responded to medication or other interventions. It's generally considered as a last resort for correcting atrial fibrillation. Also, this procedure is more likely to be considered for older patients because it requires the placement of a pacemaker.

What you can expect

Before the procedure

To be considered for AV node ablation and pacemaker implantation, you will need to undergo several tests. If you are scheduled for the procedure, your care team will talk with you about how to prepare and what to bring to the hospital.

In some cases, you may undergo the pacemaker placement several weeks before the ablation, to make sure it's working well. After an AV node ablation, the pacemaker is essential to heart function.

During the procedure

When it's time for your procedure, you will be moved to a specially equipped procedure room called the cardiac catheterization laboratory. Your doctor will insert catheters. He or she then uses electrodes in one of the catheters to apply heat (radiofrequency energy) to destroy the electrical connection between the upper and lower heart chambers (AV node). This blocks the faulty electrical impulses.

Once the AV node is destroyed, your doctor implants a small medical device to maintain a heart rhythm (pacemaker), unless your pacemaker is already in place. You will need a pacemaker for the rest of your life.


AV node ablations have a high success rate. After the procedure, your heart rate is controlled by the implanted pacemaker, so you won't need to take drugs for heart rate control. You may need to take blood thinners, depending on your risk of stroke.

Nov. 13, 2019
  1. Chatterjee NA, et al. Atrioventricular nodal ablation in atrial fibrillation: A meta-analysis and systematic review. Circulation: Arrhythmia and Electrophysiology. 2012;5:68.
  2. Ferri FF. Atrial fibrillation. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Aug. 3, 2016.
  3. Morady F, et al., eds. Atrial fibrillation: Clinical features, mechanisms, and management. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Oct. 12, 2016.
  4. January CT, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. 2014;64:2246.
  5. Barbara Woodward Lips Patient Education Center. Ablation of the pulmonary vein for atrial fibrillation. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  6. Mulpuru SK (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Oct. 10, 2016.

Atrial fibrillation ablation