Introduction: Bradycardia in a patient with persistent AF may cause syncope and heart failure and require permanent pacemaker implantation.
Results: Seventy-year-old man with persistent AF with bradycardia was referred for evaluation of pacemaker implantation. Five years ago, he was diagnosed as paroxysmal AF. At that time, total number of heart beats per 24 hours(THB) in sinus rhythm(SR) were 97,959beats/day(minimum/average/maximum heart rate(HR): 43/73/120bpm) without pauses. Two years ago, AF developed persistent with low ventricular response without medications. THB in AF were 62,210beats/day (min/ave/max: 30/44/86bpm) with 416 pauses(up to 5.6 seconds). He had mild symptoms with bradycardia, but he refused pacemaker implantation. He had no history of heart failure, hypertension, diabetes mellitus, and stroke(CHA2DS2-VASc score was 1). His left atrial(LA) diameter was 51mm. He underwent circumferential pulmonary vein isolation with LA modifications. After ablation, he returned to SR without anti-arrhythmic drugs. THB in SR were 114,163beats/day(min/ave/max: 50/80/101bpm) without significant pauses. He remained in SR in 1 year of follow up period.
Conclusions: Ablation can be one of the treatment options for persistent AF with bradycardia and may avoid permanent pacemaker implantation.