Improvement in left ventricular function by ablation of atrioventricular nodal conduction in selected patients with lone atrial fibrillation

Rodríguez, Luz M.; Smeets, Joep L.R.M.; Xie, Bo; Chillou, Christian de; Cheriex, Emile C.; Pieters, Frans; Metzger, Jacques; Dulk, Karel den; Wellens, Hein J.J.

doi:10.1016/0002-9149(93)90982-i

Cited by 167 publications

(22 citation statements)

References 22 publications

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“…The first TIC case was reported in 1913 in a young man with atrial fibrillation [13], while many cases of TICs have been reported since [12,13,14,15,16,17,18,19,20,21]. However, the incidence of TIC is unknown, and most reports consisted of small retrospective series or case studies involving patients with atrial fibrillation.…”

Section: Discussionmentioning

confidence: 99%

Changes in Metalloproteinase and Tissue Inhibitor of Metalloproteinase during Tachycardia-Induced Cardiomyopathy by Rapid Atrial Pacing in Dogs

Zhong¹,

Zhang²,

Li³

et al. 2006

Cardiology

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Background: It was the aim of this study to investigate the variation in metalloproteinase and tissue inhibitor of metalloproteinase (TIMP) connexin levels during tachycardia-induced cardiomyopathy (TIC). Methods: Canine models of TIC were established by rapid right atrial pacing at 350–400 beats per min for 8 weeks in 11 dogs, with another 6 dogs acting as sham operation group. Echocardiography, left ventricular pressure and its first derivation with time (positive and negative maximum, dp/dt_max and –dp/dt_max), as well as intracardiac electrograms were recorded before and after rapid pacing at 1, 4 and 8 weeks. Data were acquired in sinus rhythm. Ultrastructural changes in left ventricular tissue were observed by transmission electron microscope. The relative abundance of matrix metalloproteinase (MMP)-9 and TIMP-1 was studied by immunoblotting. Results: The following hemodynamic changes were detected after 8 weeks of rapid pacing: the TIC group had decreased dp/dt_max (p < 0.05), the left ventricular relaxation time constant (τ) was prolonged (p < 0.05), both left ventricular end-diastolic volume and left ventricular end-systolic volume were decreased (p <0.05), left ventricular end-diastolic pressure was significantly increased (p <0.05), and –dp/dt_max was significantly decreased (p <0.001) compared with the control group; no statistical differences in the left ventricular ejection fraction between weeks 1, 4 or 8 (p >0.05) were observed, but left ventricular ejection fraction was significantly decreased after 1 week of pacing (p < 0.05). The left ventricular end-diastolic volume was increased after 1 week of pacing compared with the control group (24.15 ± 8.15 vs.11.19 ± 4.41 ml; p <0.05), as shown by echocardiography. Compared with the control group, MMP-9 was significantly higher (0.217 ± 2.16 E-02 vs. 0.314 ± 5.263 E-02; p < 0.001), while TIMP-1 was decreased (0.230 ± 8.944 E-02 vs. 0.120 ± 9.258 E-03; p < 0.001). Conclusions: Ventricular dilatation and systolic dysfunction occurred after 1 week of rapid right atrial pacing. Enlarged and disarrayed fibers and mitochondria with disintegrated crystal and an anarchic pattern were observed. Additionally, moderate dilation of the rough endoplasmic reticulum and intercalated disk discontinuity were seen after 8 weeks of pacing, and MMP-9 was increased and TIMP-1 was decreased after the same time period.

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Section: Discussionmentioning

confidence: 99%

Changes in Metalloproteinase and Tissue Inhibitor of Metalloproteinase during Tachycardia-Induced Cardiomyopathy by Rapid Atrial Pacing in Dogs

Zhong¹,

Zhang²,

Li³

et al. 2006

Cardiology

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“…Despite the need for a permanent pacemaker, quality of life and LV systolic function are significantly improved [70]. Rate control, after catheter ablation, has been associated with an improvement in LV hemodynamics secondary to reversal of a tachycardia-induced cardiomyopathy [71][72][73][74][75][76]. In a comparative study [71] to pharmacologic rate control, ablation and insertion of a VVIR pacemaker was superior to drug therapy in controlling symptoms in 66 patients with chronic AF and heart rates greater than 90 beats/min and concomitant heart failure.…”

Section: Nonpharmacologic Therapies For Atrial Fibrillationmentioning

confidence: 99%

Maintaining stability of sinus rhythm in atrial fibrillation: Antiarrhythmic drugs versus ablation

et al. 2002

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In managing atrial fibrillation, the main therapeutic strategies include rate control, termination of the arrhythmia, and pr vention of recurrences and thromboembolic events. Rate control with digoxin, b-blockers, verapamil, and diltiazem may be preferred in drug refractory and sedentary patients with markedly dilated left atrium and atrial fibrillation of long duration. Drugs useful in the maintenance of sinus rhythm include quinidine, procainamide, disopyramide, sotalol, amiodarone, dofetilide, flecainide, and propafenone. In patients with structural heart disease, the class III antiarrhythmics are the initial drugs of choice, given their neutral effects on survival in a post-myocardial infarction and congestive heart failure population. Due to high recurrence rates with pharmacologic therapy, nonpharmacologic options of therapy include atrioventricular junction ablation, atrial defibrillators, catheter ablation of pulmonary vein foci, and attempts to perform an atrial Maze procedure using catheters. Hybrid therapy using drugs in combination with nonpharmacologic approaches will be used more frequently in the future for refractory patients.

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“…Patients may also present with varying degrees of acute and chronic ventricular systolic dysfunction as the sole manifestation of inadequately rate-controlled atrial fibrillation. The "tachycardiomyopathy" of these patients can be reversible to a considerable extent by providing adequate and sustained ventricular rate control during AF [12][13][14]. There are data suggesting that a "regularized" ventricular rate response and restoration of atrial transport function might confer additional "healing" benefit to the cardiomyopathic state [15].…”

Section: Opinion Statementmentioning

confidence: 99%

Atrial fibrillation

Marinchak

Kowey

Rials

et al. 2000

Curr Treat Options Cardio Med

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Atrial fibrillation will present the most significant arrhythmia management challenge for clinicians in the new millennium, particularly as the percentage of elderly patients and longevity increase worldwide. The clinical manifestations of the arrhythmia are wide ranging: paroxysmal to permanent modes of occurrence and asymptomatic to severely symptomatic presentations. Perhaps most important, the major risks of atrial fibrillation are stroke and death. Current therapies remain heavily focused on pharmacologic efforts to reduce the severity of primary symptoms and to prevent stroke and other thromboembolic complications by means of anticoagulation. It has not yet been proven that prevention of atrial fibrillation will prolong survival, however. Nonpharmacologic therapies remain under intense basic and clinical investigation as promising means to improve outcome further for patients suffering from atrial fibrillation.

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Improvement in left ventricular function by ablation of atrioventricular nodal conduction in selected patients with lone atrial fibrillation

Cited by 167 publications

References 22 publications

Changes in Metalloproteinase and Tissue Inhibitor of Metalloproteinase during Tachycardia-Induced Cardiomyopathy by Rapid Atrial Pacing in Dogs

Changes in Metalloproteinase and Tissue Inhibitor of Metalloproteinase during Tachycardia-Induced Cardiomyopathy by Rapid Atrial Pacing in Dogs

Maintaining stability of sinus rhythm in atrial fibrillation: Antiarrhythmic drugs versus ablation

Atrial fibrillation

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