摘要BACKGROUND Recurrence of atrial fibrillation (AF) is common in patients with persistent AF even after multiple ablation pro-cedures. His-Purkinje conduction system pacing (HPCSP) combined with atrioventricular node ablation (AVNA) is effective in ma-naging patients with AF and heart failure. This study aimed to determine whether HPCSP combined with AVNA can improve qua-lity of life and alleviate symptoms in older patients with symptomatic persistent AF refractory to multiple ablation procedures, as well as evaluate the feasibility and safety of this therapy. METHODS Older patients (≥ 65 years) with symptomatic persistent AF refractory to at least two ablation procedures were trea-ted with combined HPCSP and AVNA. The success rates and complications were recorded. Pacing parameters, European Heart Rh-ythm Association (EHRA) scores, and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scores obtained perioperatively were co-mpared with those recorded at the 6-month follow-up examination. RESULTS Thirty-one patients were enrolled; of those, only thirty patients were eventually treated with AVNA because one pa-tient developed a complete atrioventricular block following the withdrawal of the His bundle pacing lead. The success rates were 100％ for HPCSP (22 cases with His bundle pacing, and 9 cases with left bundle branch pacing) and 93.3％ (28/30) for AVNA, re-spectively. By the 6-month follow-up examination, EHRA scores improved significantly (3.00 ± 0.73 vs. 2.44 ± 0.63, P = 0.014) and AFEQT scores increased markedly (49.6 ± 20.6 vs. 70.9 ± 14.0, P = 0.001). No severe complications developed. CONCLUSIONS When used in older patients with symptomatic persistent AF refractory to multiple ablation procedures, HPC-SP combined with AVNA significantly alleviated symptoms and improved quality of life during short-term follow-up. This thera-py was proved to be safe and effective in this patient population.