Atrioventricular nodal ablation and implantation of mode switching dual chamber pacemakers: effective treatment for drug refractory paroxysmal atrial fibrillation

Abstract

Objective-To assess the eVect of atrioventricular node ablation and implantation of a dual chamber, mode switching pacemaker on quality of life, exercise capacity, and left ventricular systolic function in patients with drug refractory paroxysmal atrial fibrillation. Patients-18 consecutive patients with drug refractory paroxysmal atrial fibrillation. Methods-Quality of life was assessed before and after the procedure using the psychological general wellbeing index (PGWB), the McMaster health index (MHI), and a visual analogue scale for cardiac symptoms. Nine of the patients also underwent symptom limited exercise tests and echocardiography to assess left ventricular systolic function. Results-The procedure allowed a reduction in antiarrhythmic drug treatment (p < 0.01). PGWB and symptom scores improved (p < 0.01) but the MHI score did not change. Left ventricular systolic function and exercise capacity were unchanged. Conclusions-Atrioventricular node ablation and implantation of a DDDR/MS pacemaker is eVective treatment for refractory paroxysmal atrial fibrillation, producing improved quality of life while allowing a reduction in drug burden. The popularity of the treatment is justified, but further studies are needed to determine optimum timing of intervention. (Heart 1998;79:543-547)

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…363,387,388,[792][793][794] Baseline quality-of-life scores are generally lower for patients with AF or atrial flutter than for those undergoing ablation for other arrhythmias. 795 A meta-analysis of 10 studies of patients with AF 389 found improvement in both symptoms and quality-of-life scores after ablation and pacing.…”

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

“…791 In selected patients, radiofrequency catheter ablation of the AV node and pacemaker insertion decreased symptoms of AF and improved quality-of-life scores compared with medication therapy. 363,387,388,[792][793][794] Baseline quality-of-life scores are generally lower for patients with AF or atrial flutter than for those undergoing ablation for other arrhythmias. 795 A meta-analysis of 10 studies of patients with AF 389 found improvement in both symptoms and quality-of-life scores after ablation and pacing.…”

Prospective Randomized Study of Ablation and Pacing Versus Medical Therapy for Paroxysmal Atrial Fibrillation

“…Of the studies to date, most have been uncontrolled, retrospective, or have not distinguished between chronic AF and PAF. [3][4][5][6][7][8][9] The only prospective study comparing medical treatment for PAF with ablation and pacing suggested superiority for the latter but did not assess the optimum pacing mode 10 ; because both VVIR 4 and DDDR/MS 3 pacing have been shown to be effective, an assessment of pacing mode is required. Similarly, no study has assessed whether the modeswitching algorithm used affects the efficacy of ablation and pacing.…”