Professor Prash Sanders

That's a fantastic description.

I think the important thing, though, is there's two different types of ablation.

One is to ablate the pulmonary veins to get normal rhythm, which really we should be trying to do in most people with heart failure because it's got a proven mortality benefit.

But the second is where we damage the AV node, where we render the person dependent on the pacemaker.

The thought there is really to say that we're going to allow the pacemaker to work more efficiently by ensuring that it's going to be pacing the heart and resynchronizing it.

It's our natural electrical system that allows the top and bottom chambers to be coordinated in activity.

And so the study that we did really because the data would suggest that in people with atrial fibrillation, unless you burnt the node,

this therapy was being less effective.

And so there was a push towards undertaking this AV node ablation and rendering people dependent on the pacemaker.

And so that's where this study is hugely important because it's a randomized study.

And what it shows is that there's no difference between managing it medically or to ablate the AV node.

And so this is a scenario where we now should not be ablating the AV node universally on everyone.

but rather we need to judge which person would benefit the most from it.

The side effect is really that you make the person dependent on the pacemaker.

So if anything goes wrong with the pacemaker,

they're not going to have a backup.

There's no nature's backup when the pacemaker gives way.

So although it improves symptoms, it doesn't improve survival, it doesn't improve heart failure admissions, and it renders them without any rhythm if the pacemaker should fail or get infected.

Yes.

So I think this is an area that we're going to need to study, but we need to get the heart rates down because if the heart rates are going very fast, say over 120 beats a minute or