Preserved Left Ventricular Ejection Fraction Following Atrioventricular Junction Ablation and Pacing for Atrial Fibrillation

Chen, Lin Y.; Hodge, David O.; Jahangir, Arshad; Özcan, Cevher; Trusty, R N Jane; Friedman, Paul A.; Rea, Robert F.; Bradley, David J.; Brady, Peter A.; Hammill, Stephen C.; Hayes, David L.; Shen, Win‐Kuang

doi:10.1111/j.1540-8167.2007.00994.x

Cited by 54 publications

(47 citation statements)

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“…The antibody status of these patients was not reported, and it is possible that mechanisms other than ventricular dyssynchrony such as immune-mediated alterations in ventricular function may have contributed to LV dysfunction. 9 As shown by Chen et al, 15 most patients requiring ablation of the atrioventricular junction for atrial fibrillation do not develop deterioration in ventricular function with RV pacing, suggesting that ventricular dyssynchrony alone may not be responsible for worsening HF. ICAVB commonly occurs in children born to mothers with systemic lupus erythematosus.…”

Section: Discussionmentioning

confidence: 86%

“…Although recent studies have reported pacing-induced ventricular remodeling and poor outcomes in patients with ICAVB, risk factors associated with the detrimental effect of pacing continue to be poorly defined. 8,9 Immune-mediated cardiomyopathy has been recognized in patients with a positive rheumatoid factor test result [12][13][14][15][16] and in infants born to mothers with antinuclear antibodies (ANAs). 12,[17][18][19][20] Thus, we hypothesized that the presence of ANA in adult congenital ICAVB patients may be associated with worse outcomes after pacemaker implantation.…”

Section: Clinical Perspective On P 1705mentioning

confidence: 99%

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Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

et al. 2010

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Background-Right ventricular pacing increases the risk of heart failure in adults with structural heart disease. The impact of prolonged right ventricular pacing in adults without structural heart disease is not fully characterized and may depend on interactions of pacing with abnormal substrate predisposing to ventricular dysfunction. Methods and Results-We assessed the effect of right ventricular pacing in patients who underwent pacemaker implantation for isolated congenital atrioventricular block between 1964 and 2005. To assess for immunologic contribution to cardiac dysfunction, outcomes were compared between patients with (Ab ϩ ) and without (Ab Ϫ ) antinuclear antibody during adulthood and an age-and sex-matched Olmsted County, Minnesota, population. Of 103 patients (meanϮSD age, 32Ϯ19 years), 18 were Ab

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Section: Discussionmentioning

confidence: 86%

Section: Clinical Perspective On P 1705mentioning

confidence: 99%

Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

et al. 2010

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“…Although a single‐center retrospective study suggested that AVJA, followed by RV pacing, was not associated with an adverse impact on left ventricular (LV) ejection fraction,16 this was not confirmed by a randomized clinical trial, especially in patients with underlying LV dysfunction or symptomatic HF 4. Furthermore, the deleterious effect of RV pacing was mitigated by the use of biventricular pacing.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal

Musat

Hoskins

et al. 2017

JAHA

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BackgroundPatients with atrial fibrillation (AF) often undergo AV junction ablation (AVJA) and pacemaker implantation. Right ventricular (RV) pacing contributes to increased risk of heart failure (HF), which may be mitigated by biventricular pacing. We sought to determine the impact of AVJA concurrent with RV versus biventricular pacemaker implantation on AF and HF hospitalizations.Methods and ResultsThe MarketScan Commercial and Medicare Supplemental claims database was used to select 18‐ to 100‐year‐old patients with AF with pacemaker implantation. Patients were divided into those with an RV and a biventricular pacemaker and further into those who did (AVJA +) or did not undergo concurrent ablation. Separately, the AVJA+ group was divided into those receiving RV versus biventricular pacemakers. AF and HF hospitalization rates were compared between groups after matching on demographics, comorbidities, and baseline hospitalization rates. The study included 24 361 patients, with RV (n=23 377) or biventricular (n=984) pacemakers; 1611 patients underwent AVJA. AVJA + was associated with reduced AF hospitalization risk (RV hazard ratio [HR], 0.31; P<0.001; biventricular HR, 0.20; P=0.003) compared with no AVJA. However, HF hospitalization risk was increased for RV (HR, 1.63; P=0.001), but not biventricular (HR, 0.98; P=0.942), pacemakers. In AVJA + patients, biventricular pacing was associated with reduced risk of HF hospitalization versus RV pacing (HR, 0.62; P=0.017).ConclusionsIn a large cohort of patients with AF, AVJA + significantly reduced AF hospitalizations, irrespective of whether an RV or a biventricular pacemaker was implanted. However, AVJA was associated with a marked HF hospitalization increase in patients with an RV pacemaker, which was ameliorated with biventricular pacing.

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“…In a cohort of 286 patients at the Mayo clinic undergoing AVJ ablation with RV apical pacing, at a mean follow-up of 20 months, no significant change in LVEF was noted compared with baseline. 24 Additionally, the cumulative 10-year probability of HF hospitalization after AVJ ablation was only 8%. Similar findings were reported recently from a European single-center registry, which suggested that many patients with high-burden RV pacing maintain stable LVEF with a low incidence of new-onset HF.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results-A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB.Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions-Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. Study PopulationPatients were selected for study inclusion if they were implanted with a de novo dual-chamber pacemaker (Current Procedural Terminology code 33208 and Healthcare Common Procedure Coding System codes C1785 and C2619) from any manufacturer between April 1, 2008, and March 31, 2014. Patients with a left ventricular lead placed (Current Procedural Terminology codes 33224 or 33225) at the time of pacemaker implantation were excluded. De novo implants were identified as pacemaker patients without a previous device implantation and without a remote or in-office pacemaker follow-up visit in the 1 year before implantation. An enrollment indicator confirmed active inclusion in the MarketScan databases for each patient per month. Patients were required to have at least 1 year of continuous enrollment in the MarketScan database before and after pacemaker implantation and to be ≥18 and ≤100 years of age at the time of pacemaker implantation.To evaluate the impact of atrioventricular block (AVB) on the development of HF after pacemaker implantation, patients wi...

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Preserved Left Ventricular Ejection Fraction Following Atrioventricular Junction Ablation and Pacing for Atrial Fibrillation

Cited by 54 publications

References 53 publications

Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

Effect of Long-Term Right Ventricular Pacing in Young Adults With Structurally Normal Heart

Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

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