In drug refractory and highly symptomatic atrial fibrillation (AF) patients, hemodynamic effects of AV node ablation and pacing therapy (APT) were evaluated. Thirty-eight patients with drug refractory and symptomatic AF, underwent APT in eight centers in Japan. The outcome of this therapy was assessed in terms of quality-of-life, cardiac performance measured by echocardiogram, and plasma ANP and BNP levels before and after APT. Quality-of-life assessed by self-administered semi-quantitative questionnaires: WHO QOL 26 (3.0 +/- 0.5 vs 3.4 +/- 0.6, P < 0.01) and the Symptom Checklist: Frequency Scale (1.6 +/- 0.6 vs 0.7 +/- 0.7, P < 0.01) and Severity Scale (1.3 +/- 0.4 vs 0.6 +/- 0.6, P < 0.01), improved significantly 6 months after APT. Ejection fraction (EF) by echocardiogram improved 1 week after APT (59.0% +/- 13.3% vs 63.3% +/- 11.6%, P = 0.02). Plasma ANP levels in the group of ANP > 40 pg/mL at enrollment significantly decreased 1 month later (P = 0.03), and plasma BNP levels in the group of BNP > 20 pg/mL at enrollment significantly decreased 1 month later (P < 0.01). In conclusion, APT has beneficial hemodynamic effects, and plasma BNP levels can predict the most optimal candidates for ablation and pacing therapy.