What is the indication for surgical ablation (AV node ablation) for atrial fibrillation?

Patients with atrial fibrillation and have difficulty controlling their rate can be treated with an AV node ablation which is a procedure that damages the AV node so that it won’t conduct the beat. This results in complete heart block and is treated with a pacemaker. More recent treatments for AF include an AF ablation which gets rid of the AF directly and does not require a pacemaker.