This chapter presents a clinical case in which left bundle branch area pacing (LBBAP) was combined with atrioventricular (AV) node ablation within the same procedure as part of an ablate-and-pace strategy for atrial fibrillation with rapid rate nonresponsive to negative chronotropic medications. LBBAP was successfully achieved using trans-septal lead deployment guided by fluoroscopy, uninterrupted pacing technique, and intracardiac electrogram assessment. Stable non-selective left bundle branch capture with appropriate stimulus-to-left ventricular activation time (V6RWPT) was obtained before proceeding to AV node ablation. Subsequent AV nodal modification resulted in complete and controlled ventricular pacing dependency without compromising conduction system capture or electrical stability. This case highlights key procedural considerations for integrating physiologic pacing with AV node ablation in the ablate-and-pace setting.