Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction. Results of a prospective, international, multicenter study.

Abstract

Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.

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

“…There is also a finite risk of sudden death due to torsades de pointes or ventricular fibrillation. 396 Patients with abnormalities of diastolic ventricular compliance who depend on AV synchrony to maintain cardiac output, such as those with hypertrophic cardiomyopathy or hypertensive heart disease, may experience persistent symptoms after AV nodal ablation and pacemaker implantation. Hence, patients should be counseled regarding each of these considerations before proceeding with this irreversible measure.…”

Atrioventricular Conduction in Atrial Fibrillation: Pathophysiology and Clinical Implications

“…The 1-year mortality rate after AV nodal ablation and permanent pacemaker implantation is approximately 6.3%, with 2.0% risk of sudden death. Although a causal relationship between the procedure and sudden death still remains controversial, the pacemaker is routinely set to a high basic rate, such as 90/minute for the first month after ablation, to avoid bradycardia-induced tachyarrhythmias after a prolonged period of rapid ventricular rate (Evans et al, 1991). Although the symptomatic benefits of AV nodal ablation are clear, limitations include the persistent need for anticoagulation, loss of AV synchrony, and lifelong pacemaker dependency.…”

Implanted Devices and Atrial Fibrillation

“…In fact, the 1-year mortality rate after ablate and pace is approximately 6.3%, which include a 2% risk of sudden cardiac death [54]. Although this issue has raised some criticisms, programming a higher lower rate of about 80-90 beats per minute for the first 1-2 months seems a viable option for reducing the risk of sudden death [55]. Nonetheless, mortality associated with ablate and pace is still low, reaching 10.5% in 5 years [56], with no significant difference in mortality between ablation and pharmacological control rate.…”