Left bundle branch pacing combined with atrioventricular node ablation in atrial fibrillation with severe aortic stenosis: A case report

RATIONALE: In patients with atrial fibrillation (AF) complicated by severe aortic stenosis (AS), atrioventricular node ablation (AVNA) combined with permanent pacemaker implantation is an effective treatment strategy, especially when conventional rhythm control methods fail. PATIENT CONCERNS: An 88-year-old female with a 40-year history of paroxysmal palpitations and chest tightness, with significant worsening of symptoms over the past 20 days. Despite undergoing AF ablation 5 years ago, her symptoms and arrhythmia burden persisted. DIAGNOSIS: Long-standing (24 years) AF, severe AS, and a history of failed radiofrequency catheter ablation for AF. INTERVENTIONS: The patient underwent left bundle branch pacing followed by AVNA. OUTCOMES: During the 9-month follow-up period, her palpitations completely resolved, with no recorded atrial arrhythmias. The AF's impact on quality of life score significantly improved, and her performance on the 6-minute walk test markedly increased, indicating significant functional enhancement. LESSONS: This case demonstrates that left bundle branch pacing combined with AVNA is clinically effective and technically feasible for AF patients in the elderly population with severe AS, particularly when conventional rhythm control methods fail. This approach offers an effective option for symptom relief and functional improvement in this challenging patient population.