Patients with symptomatic atrial fibrillation not amenable to pharmacologic therapy or catheter ablation may be appropriate candidates for atrioventricular nodal (AVN) ablation and placement of a permanent pacemaker. The question arises as to whether to implant a right ventricular (RV)-only pacing device or a cardiac resynchronization therapy (CRT) device. This article examines 2 similar cases of patients presenting for AVN ablation who received RV-only pacing devices but had different clinical outcomes. This article discusses existing guidelines and studies that can help clinicians address the challenging question of whether an initial implant of a CRT pacing device is warranted in such patients.