Assessment of Atrioventricular Junction Ablation and VVIR Pacemaker Versus Pharmacological Treatment in Patients With Heart Failure and Chronic Atrial Fibrillation

Brignole, Michele; Menozzi, Carlo; Gianfranchi, Lorella; Musso, Giacomo; Mureddu, Roberto; Bottoni, Nicola; Lolli, Gino

doi:10.1161/01.cir.98.10.953

Cited by 301 publications

(182 citation statements)

References 33 publications

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“…25 Randomized prospective studies comparing the ''ablate and pace'' modality and pharmacological management in patients with LV dysfunction are rare, and patients of these studies included not only some pure TIC but also many structural heart diseases. 26,27 Present study included only pure TIC patients. We found that control of heart rate was comparable to restoration of sinus rhythm for symptoms and echocardiographic parameters.…”

Section: Treatment Methods and Clinical Outcomesmentioning

confidence: 99%

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Jeong

Choi

Song

et al. 2008

Clinical Cardiology

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Background: Due to the absence of differential guidelines for heart failure with tachyarrhythmia, it is difficult to diagnose tachycardia-induced cardiomyopathy (TIC) at the initial visit. Furthermore, clinical outcomes of rate versus rhythm control in TIC are unclear. Hypothesis: Because the etiology of TIC is different from dynamic cardiomyoplasty (DCMP), differential parameters may be present. Methods: We assessed 21 patients with TIC (15 men; mean age, 50 ± 14 years) and 21 control patients with idiopathic DCMP. We assessed clinical courses, echocardiographic parameters, as well as outcomes by treatment.Results: In the TIC group, the related tachyarrhythmias were atrial fibrillation (n = 12), atrial flutter (n = 5), atrial tachycardia (n = 3) and paroxysmal supraventricular tachycardia (n = 1). After treatment, all patients became asymptomatic and the ejection fraction (EF) improvement ( EF 15%) was observed in all patients (left ventricular ejection fraction [LVEF], 30 ± 11% initial versus 58 ± 6% last ). In the idiopathic DCMP group, no patient showed EF improvement (EF increase 5%), and 4 patients (19%) underwent heart transplantation. Left ventricle (LV) mass indices, volumes adjusted by BSA, and dimensions were smaller in the TIC group than in the idiopathic DCMP group. Of those, LV end-diastolic dimension was the only independent predictor of TIC in multiple regression analysis (odds ratio [OR] 0.742 per 1 mm, 95% confidence ratio [CI] 0.618 to 0.891, p = 0.001). The Association of University Cardiologists (AUC) was 0.908 on receiver-operating characteristic (ROC) curve analysis and LV end-diastolic dimension 61 mm could predict TIC with a sensitivity of 100% and a specificity of 71.4%. After restoration of sinus rhythm (n = 8), one experienced recurrent TIC after discontinuation of amiodarone. After control of heart rate (n = 13), one experienced recurrent TIC due to poor control of heart rate (log-rank test, p = 0.808). There were no differences in the echocardiographic parameters between the 2 groups before and after treatment except for the larger initial LV volumes in the rhythm control. Conclusions: In patients presented as heart failure with tachyarrhythmia, initial echocardiographic parameters, especially LV end-diastolic dimension, help to differentiate TIC from idiopathic DCMP. Rate control was as effective as rhythm control for EF improvement and prognosis.

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Section: Treatment Methods and Clinical Outcomesmentioning

confidence: 99%

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Jeong

Choi

Song

et al. 2008

Clinical Cardiology

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“…Аблация атриовентрикулярного узла в сочетании с имплантацией водителя ритма является высоко эф-фективным методом контроля ЧСС и вызывает умень-шение симптомов [140][141][142][143]. Наибольшего эффекта удается добиться при наличии симптомов или кар-диомиопатии, связанных с тахикардией, которую не уда-ется контролировать с помощью антиаритмических или хронотропных препаратов.…”

Section: с аблация атриовентрикулярного узлаunclassified

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Ryden²,

Cannom³

et al. 2007

Racionalʹnaâ farmakoterapiâ v kardiologii

120

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Отчет рабочей группы Американской коллегии кардиологов и Американской ассоциации сердца по практическим рекомендациям и комитета Европейского общества кардиологов по практическим рекомендациям Рекомендации разработаны в сотрудничестве с Европейской ассоциацией сердечного ритма и Обществом сердечного ритма Авторы (члены рабочей группы): V.

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“…79 In a randomized controlled study of 66 persons with CHF and chronic AF, AV junction ablation with implantation of a VVIR pacemaker was superior to drug treatment in controlling symptoms. 80 Long-term survival is similar for patients with AF whether they receive radiofrequency ablation of the AV node and implantation of a permanent pacemaker or drug therapy. 81 In 44 patients, mean age 78±5 years, radiofrequency catheter ablation followed by pacemaker implantation was successful in ablating the AV junction in 43 of 44 patients (98%) with AF and a rapid ventricular rate not controlled by drug therapy.…”

Section: Journal Of Atrial Fibrillationmentioning

confidence: 99%

Atrial Fibrillation: The New Epidemic of the Ageing World

Aronow¹,

Banach²

2009

J.A.F.I.B

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The prevalence of atrial fibrillation (AF) increases with age. As the population ages, the burden of AF increases.AF is associated with an increased incidence of mortality, stroke, and coronary events compared to sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current (DC) cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, diltiazem, or verapamil may be administered to reduce immediately a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nondrug therapies should be performed in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. Paroxysmal AF associated with the tachycardia-bradycardia syndrome should be treated with a permanent pacemaker in combination with drugs. A permanent pacemaker should be implanted in patients with AF and symptoms such as dizziness or syncope associated with ventricular pauses greater than 3 seconds which are not drug-induced. Elective DC cardioversion has a higher success rate and a lower incidence of cardiac adverse effects than does medical cardioversion in converting AF to sinus rhythm. Unless transesophageal echocardiography has shown no thrombus in the left atrial appendage before cardioversion, oral warfarin should be given for 3 weeks before elective DC or drug cardioversion of AF and continued for at least 4 weeks after maintenance of sinus rhythm. Many cardiologists prefer, especially in elderly patients , ventricular rate control plus warfarin rather than maintaining sinus rhythm with antiarrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin 325 mg daily

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Assessment of Atrioventricular Junction Ablation and VVIR Pacemaker Versus Pharmacological Treatment in Patients With Heart Failure and Chronic Atrial Fibrillation

Cited by 301 publications

References 33 publications

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

American College of Cardiology, American Heart Association and European Society of Cardiology (2006) Guidelines for the Management of Patients With Atrial Fibrillation

Atrial Fibrillation: The New Epidemic of the Ageing World

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