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Gn, Kay; Ka, Ellenbogen; Giudici, Michael; Mm, Redfield; Ls, Jenkins; Mianulli, Marcus; Wilkoff, Bruce L.

doi:10.1023/a:1009795330454

Cited by 252 publications

(17 citation statements)

References 34 publications

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“…Our findings of improved clinical outcomes in HFrEF patients are similar to the findings in the reports of His bundle pacing in heart failure patients with or without atrial fibrillation 12, 16, 18. Previous studies demonstrated a significant improvement in echocardiographic LVEF or LV fractional shortening by 30% to 40% following AVN ablation and permanent RV pacing for refractory AF in HFrEF patients whose baseline heart rate was not controlled during AF 27, 28, 29. The mechanism of the improvement we observed was likely multifactorial and included improved heart rate control by pacing post–AVN ablation.…”

Section: Discussionsupporting

confidence: 87%

“…The mechanism of the improvement we observed was likely multifactorial and included improved heart rate control by pacing post–AVN ablation. The magnitude of LV function improvement in HFrEF patients in the present study appeared greater when compared to previous studies,27, 28, 29 likely due to synchronized ventricular contraction with HBP pacing post–AVN ablation. More importantly, the present study demonstrated that improvement after permanent HBP was inversely proportional to baseline ventricular function.…”

Section: Discussioncontrasting

confidence: 76%

“…Previous studies in HFpEF patients who underwent AVN ablation and permanent RV pacing for refractory AF showed inconsistent results with respect to improvement in LV function 1, 2, 28, 29. Permanent RV pacing may not be an ideal option for patients with diastolic heart failure with preserved ejection fraction 4, 30.…”

Section: Discussionmentioning

confidence: 98%

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Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Huang

et al. 2017

JAHA

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184

122

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BackgroundClinical benefits from His bundle pacing (HBP) in heart failure patients with preserved and reduced left ventricular ejection fraction are still inconclusive. This study evaluated clinical outcomes of permanent HBP in atrial fibrillation patients with narrow QRS who underwent atrioventricular node ablation for heart failure symptoms despite rate control by medication.Methods and ResultsThe study enrolled 52 consecutive heart failure patients who underwent attempted atrioventricular node ablation and HBP for symptomatic atrial fibrillation. Echocardiographic left ventricular ejection fraction and left ventricular end‐diastolic dimension, New York Heart Association classification and use of diuretics for heart failure were assessed during follow‐up visits after permanent HBP. Of 52 patients, 42 patients (80.8%) received permanent HBP and atrioventricular node ablation with a median 20‐month follow‐up. There was no significant change between native and paced QRS duration (107.1±25.8 versus 105.3±23.9 milliseconds, P=0.07). Left ventricular end‐diastolic dimension decreased from the baseline (P<0.001), and left ventricular ejection fraction increased from baseline (P<0.001) in patients with a greater improvement in heart failure with reduced ejection fraction patients (N=20) than in heart failure with preserved ejection fraction patients (N=22). New York Heart Association classification improved from a baseline 2.9±0.6 to 1.4±0.4 after HBP in heart failure with reduced ejection fraction patients and from a baseline 2.7±0.6 to 1.4±0.5 after HBP in heart failure with preserved ejection fraction patients. After 1 year of HBP, the numbers of patients who used diuretics for heart failure decreased significantly (P<0.001) when compared to the baseline diuretics use.ConclusionsPermanent HBP post–atrioventricular node ablation significantly improved echocardiographic measurements and New York Heart Association classification and reduced diuretics use for heart failure management in atrial fibrillation patients with narrow QRS who suffered from heart failure with preserved or reduced ejection fraction.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 76%

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Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Huang

et al. 2017

JAHA

Self Cite

184

122

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“…Ablation of a compact AV node, being currently a standard radio-frequency ablation procedure, has almost a 100% success rate, has a short duration and presents very few complications [50, 51]. Patients have permanent pacemakers implanted which are programmed to rate responsive VVI,R mode (adjusting rate according to the physiologic needs of the patient).…”

Section: Atrioventricular (Av) Node Ablation and Permanent Pacemaker mentioning

confidence: 99%

“…The APT trial [51], prospectively assessing quality of life, survival, exercise capacity and ventricular function in 156 patients within 12 months of AV node ablation for atrial fibrillation, has proved moderate improvement in left ventricular function, mostly exhibited in patients with severe left ventricular dysfunction at baseline reporting increase in LV ejection fraction from 31% to 41%. All patients demonstrated NYHA functional class improvement from 2.1 to 1.8 and noted significant improvement in quality of life.…”

Section: Atrioventricular (Av) Node Ablation and Permanent Pacemaker mentioning

confidence: 99%

Hybrid Therapy in the Management of Atrial Fibrillation

Stárek¹,

Lehar²,

Jež³

et al. 2014

CCR

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Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.

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Quality of Life in Patients With Atrial Fibrillation

Lüderitz¹,

Jung²

2000

Arch Intern Med

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Atrial fibrillation (AF) is a frequent and costly health care problem. In patients with AF, the restoration and maintenance of sinus rhythm is the primary therapeutic goal. The most frequent strategy for maintaining sinus rhythm after restoration is the use of antiarrhythmic drugs. The efficacy of therapy in AF has been predominantly measured using objective criteria such as mortality and morbidity. In recent years, the importance of quality of life (QoL) as an outcome measure has been recognized. However, few studies in the literature have examined QoL in patients with AF using properly validated tools. In addition, the specific impact of antiarrhythmic drug treatment on QoL in patients with AF has not been assessed. These issues are now being addressed in several ongoing studies. This article attempts to define QoL, makes recommendations on how QoL might be assessed, reviews our current knowledge regarding QoL in patients with AF, and discusses new clinical trials currently assessing QoL in patients with AF.

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Abstract: Catheter ablation of the AV conduction system and permanent pacemaker implantation were associated with improved quality of life and left ventricular function in this population of highly symptomatic patients with atrial fibrillation refractory to medical therapy.

Cited by 252 publications

References 34 publications

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Hybrid Therapy in the Management of Atrial Fibrillation

Quality of Life in Patients With Atrial Fibrillation

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