International Circulation: In patients with atrial fibrillation and left ventricular dysfunction， which one is better， catheter ablation combined with implantation of right ventricular pacemaker or combined with CRT? Can you share us with your opinion?

Gerhard Hindricks : This is a very interesting question because the interaction between atrial fibrillation and heart failure is very interesting on one side and very dangerous from the patient’s perspective.  Heart failure leads to atrial fibrillation and atrial fibrillation leads to heart failure so they are intimately linked.  In my view there are three different options of how to treat these patients， the first option being catheterization of atrial fibrillation.  There is an increasing number of studies being published showing that you can increase， tremendously， left ventricular function with non-pharmacological restoration of sinus rhythms.  This is a very important therapeutic strategy.  When a different therapeutic strategy is desired， with catheterization of the AV node and pacemaker implantation， the question is whether implantation of a right ventricular lead sufficient or do these patients require CRT therapy or biventricular stimulation?  For this question I have a clear-cut answer; these patients need resynchronization.  We know from many studies that right ventricular pacing， especially when the patients are permanently paced and the left ventricular function is reduced， is deleterious to the ventricle.  You will then see a further decrease in left ventricular function so my clear-cut answer is for CRT in all of these patients.