Assessment of Atrioventricular Junction Ablation and DDDR Mode-Switching Pacemaker Versus Pharmacological Treatment in Patients With Severely Symptomatic Paroxysmal Atrial Fibrillation

Brignole, Michele; Gianfranchi, Lorella; Menozzi, Carlo; Alboni, Paoló; Musso, Giacomo; Bongiorni, Maria Grazia; Gasparini, Maurizio; Raviele, Antonio; Lolli, Gino; Paparella, Nelly; Acquarone, S.

doi:10.1161/01.cir.96.8.2617

Cited by 215 publications

(134 citation statements)

References 32 publications

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“…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%

“…Multiple clinical studies have demonstrated improved quality of life following atrioventricular node (AVN) ablation and permanent right ventricular (RV) pacing in patients with symptomatic atrial fibrillation (AF) refractory to optimal medical therapy 1, 2, 3, 4. However, several studies performed over the last decade have demonstrated that conventional long‐term RV apical pacing can increase the risk of death and heart failure hospitalization 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

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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

181

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: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

181

122

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“…6 Our results relating stroke to hypertension, systolic blood pressure, and diabetes in AF patients are also similar to published studies in developed countries. 7,8 However, the findings of severity of hypertension relating to risk of stroke appear to be particularly interesting. Although the systolic blood pressure taken on admission was casual, we think that the control of blood pressure was poor for those patients with high systolic blood pressure.…”

Section: Risk Factors For Stroke In Nonrheumatic Af Patientsmentioning

confidence: 99%

Predictors of Stroke Risk in Native Chinese with Nonrheumatic Atrial Fibrillation: Retrospective Investigation of Hospitalized Patients

Sun

et al. 2009

Clinical Cardiology

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Background: Data on stroke risk factor profiles and atrial fibrillation (AF) for the Chinese population are sparse. This study identified risk factors for stroke among native Chinese with nonrheumatic AF. Methods: In this retrospective investigation, patients diagnosed with nonrheumatic AF were identified from 18 hospitals in representative areas of the country, from January 2000 to April 2002, based on the medical records. All parameters relevant to AF were compared between AF patients with stroke and those without. The independent risk factors for stroke were assessed with a logistic regression analysis. Results: Patients numbering 3,425 with AF were included, among whom 827 subjects were discharged on account of stroke. The prevalence of stroke in nonrheumatic AF patients was 24.15%. AF patients with stroke were significantly older than controls (73.31±9.18 versus 68.22±12.29 y, p<0.001) and more likely to have a history of hypertension (71.0 versus 51.6%, p<0.001) and diabetes (17.9 versus 11.1%, p = 0.001). Both, systolic and diastolic blood pressure, are significantly higher in patients with stroke. Of all the parameters of echocardiography, there was strong evidence that left atrial (LA) thrombi significantly increased risk of stroke. Patients with persistent AF were more likely to have stroke than paroxysmal AF patients, while lone AF is less in patients with stroke than in those without. The rate of anticoagulation treatment is only 9.27%, but there were no significant differences between the 2 groups. In multivariate analysis, age ≥75 y (odds ratio [OR] 1.76; 95% confidence interval [CI] 1.08-2.98), history of hypertension (OR 1.52; 95% CI 1.28-1.80), diabetes (OR 1.39; 95% CI 1.11-1.76), high systolic blood pressure (OR 1.71; 95% CI 1.21-2.28), LA thrombi (OR 2.77; 95% CI 1.25-6.13) were independent predictors for stroke. Conclusions:The prevalence of stroke in hospitalized nonrheumatic AF patients was high. The populationspecific risk factors for stroke were age ≥75 y, diabetes, history of hypertension, high systolic blood pressure and LA thrombi by transesophageal echocardiography (TEE). These merit further evaluation.

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“…Indeed, in contrast to other ablative procedures in which the ablation erases the electrophysiologic substrate of the disease, ablate and pace only works indirectly, changing an irregular and fast ventricular rate into a regular, pacemaker-dependent, normofrequent rate. It could also be said that ablate and pace replaces one disease (uncontrolled AF) with another (iatrogenic complete AV block) [49]. Moreover, the procedure is completed by a pacemaker implant, with all the short-and long-term complications associated with a device implant procedure.…”

Section: Rationale and Indications For Ablate And Pacementioning

confidence: 99%

Implanted Devices and Atrial Fibrillation

Guerra¹,

Brambatti²,

Matassini³

et al. 2012

Current Issues and Recent Advances in Pacemaker Therapy

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Assessment of Atrioventricular Junction Ablation and DDDR Mode-Switching Pacemaker Versus Pharmacological Treatment in Patients With Severely Symptomatic Paroxysmal Atrial Fibrillation

Cited by 215 publications

References 32 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

Predictors of Stroke Risk in Native Chinese with Nonrheumatic Atrial Fibrillation: Retrospective Investigation of Hospitalized Patients

Implanted Devices and Atrial Fibrillation

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