Long-Term Survival after Ablation of the Atrioventricular Node and Implantation of a Permanent Pacemaker in Patients with Atrial Fibrillation

Özcan, Cevher; Jahangir, Arshad; Friedman, Paul A.; Patel, Philip; Munger, Thomas M.; Rea, Robert F.; Lloyd, Margaret A.; Packer, Douglas L.; Hodge, David O.; Gersh, Bernard J.; Hammill, Stephen C.; Shen, Win‐Kuang

doi:10.1056/nejm200104053441403

Cited by 278 publications

(150 citation statements)

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“…In one study, as many as 35% of the patients with heart failure had concomitant atrial fibrillation. 22 Therefore, it may be difficult to distinguish pure TIC from idiopathic DCMP with tachyarrhythmia at the initial visit.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Jeong

Choi

Song

et al. 2008

Clinical Cardiology

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“…Zabieg ten nie pogarsza czynności lewej komory [567], a nawet może poprawiać LVEF u wybranych pacjentów [568][569][570]. U wybranych pacjentów z HFrEF, u których zastosuje się stymulację dwukomorową (terapię resynchronizującą), AF może ustąpić [571], choć ten efekt "kontroli rytmu" terapii renchronizującej jest prawdopodobnie mały i z pewnością wymaga potwierdzenia [572].…”

Section: Długoterminowa Kontrola Częstości Rytmu Komór W Afunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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“…There have been concerns about sudden death following AVJAP (16,17), possibly due to bradycardia-dependent QT prolongation leading to ventricular fibrillation (16,17), but recent publications have reported that AVJAP is not associated with increased risk of sudden cardiac death (18,19).…”

Section: Discussionmentioning

confidence: 99%

The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

Weerasooriya¹,

Davis²,

Powell³

2003

ACC Current Journal Review

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OBJECTIVESThe Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial was a multicenter trial of atrioventricular junction ablation and pacing (AVJAP) compared with pharmacologic ventricular rate control (medication [MED]) in patients with mild to moderately symptomatic permanent atrial fibrillation (AF). BACKGROUND There have been very few prospective randomized trials, undertaken in highly symptomatic patients, comparing AVJAP with pharmacologic methods of ventricular rate control for patients with permanent AF. METHODSThere were 99 patients (70 men, mean age 68 Ϯ 8.6 years) at five centers. Forty-nine patients were randomized to AVJAP while 50 patients were randomized to pharmacologic control. The primary end point was cardiac function measured by echocardiography and exercise tolerance. The secondary end points were ventricular rate control, evaluated by 24-h ambulatory electrocardiographic monitoring, and quality of life. Data were collected at randomization and then at one month, six months, and 12 months post-randomization. RESULTSAt 12 months follow-up there was no significant difference in left ventricular ejection fraction (AVJAP: 54 Ϯ 17%; MED: 61 Ϯ 13% [p ϭ ns]) or exercise duration on treadmill testing (AVJAP: 4.1 Ϯ 2 min; MED: 4.6 Ϯ 2 min [p ϭ ns]); however, the peak ventricular rate was lower in the AVJAP group during exercise (112 Ϯ 17 beats/min vs. 153 Ϯ 36 beats/min, p Ͻ 0.05) and activities of daily life (117 Ϯ 16 beats/min vs. 152 Ϯ 37 beats/min, p Ͻ 0.05).The CAST quality-of-life questionnaire revealed that patients in the AVJAP group had fewer symptoms at six months (p ϭ 0.003) and at 12 months (p ϭ 0.004). The observed relative risk reduction in symptoms at 12 months was 18%. Global subjective semiquantitative measurement of quality of life using the "ladder of life" revealed that the AVJAP group reported a 6% better quality of life at six months (p ϭ 0.011). Atrial fibrillation (AF) is the most common chronic tachyarrhythmia, affecting 5% of people over the age of 60 (1). Ventricular rate control is a major treatment aim for patients with permanent AF. Although several studies have com- See page 1703pared atrioventricular junction ablation and pacing (AVJAP) with pharmacologic ventricular rate control in AF, earlier studies were not randomized (2-4), and the few published randomized prospective studies comparing the two treatment options have included very symptomatic patients with a mean left ventricular ejection fraction (LVEF) Ͻ50 (5,6). The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial (AIRCRAFT) was a multicenter, prospective randomized trial of AVJAP versus pharmacologic treatment for ventricular rate control and was undertaken in patients with permanent AF who had mild to moderate symptoms, preserved LVEF, and a ventricular rate that was controlled pharmacologically. AVJAP has not been compared to pharmacologic therapy in this population, which represents the great majority of patients with permanent AF.The primary end point...

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Long-Term Survival after Ablation of the Atrioventricular Node and Implantation of a Permanent Pacemaker in Patients with Atrial Fibrillation

Cited by 278 publications

References 32 publications

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

Diagnostic Approach and Treatment Strategy in Tachycardia‐induced Cardiomyopathy

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

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