Symptomatic Improvement After AV Nodal Ablation and Pacemaker Implantation for Refractory Atrial Fibrillation and Atrial Flutter

Abstract

Symptomatic Improvement was evaluated in 64 patients with drug-refractory atrial fibrillation or atrial flutter who underwent atrioventricular (AV) nodal ablation and permanent pacemaker implantation. The arrhythmias were chronic in 40 patients and paroxysmal in 24 patients. All were refractory to multiple drugs (3.7 +/- 1.5) and had severe symptoms: palpitations (58 patients), dyspnea (n=58), dizziness (n=38), asthenia (n=37), and chest pain (n=20). All underwent AV nodal ablation and single- (n=39) or dual-chamber (n=25) pacemaker implantation. During follow-up of 20.4 +/- 17.8 months, palpitations improved in 100% of 58 patients who had palpitations before the ablation, dyspnea improved in 75% of 58 patients, chest pain in 95% of 20 patients, asthenia in 75% of 37 patients, and dizziness in 93% of 38 patients. Moderate to significant improvement in these symptoms was reported in 83% of patients and mild improvement in 5%. Before ablation, 77% of patients were in New York Heart Association functional class III or IV. After ablation, 19% of patients were in the same functional classes (P < 0.05). Thus, AV nodal ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation or flutter was associated with significant improvement in presenting symptoms and functional capacity. A randomized, controlled study is needed to compare this form of therapy with other therapeutic modalities.

Atrioventricular Junction Ablation and Pacemaker Therapy in Patients with Drug‐Resistant Atrial Tachyarrhythmias after the Fontan Operation

“…For patients with intractable atrial fibrillation, AV nodal ablation has been recommended as an alternative treatment option 25 . Concomitant pacemaker implantation improves cardiac performance, exercise tolerance, and quality of life in adult patients with atrial flutter or atrial fibrillation 26,38,39 . Likewise, we noted a significantly improved clinical status of our patients, although 2 patients were still in IART or atrial ectopic tachycardia.…”

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure

“…Although those symptoms that result from a fast and irregular ventricular rate may show dramatic improvement, the symptoms that occur from the loss of atrial contraction and AV synchrony are unlikely to improve. This procedure leads to rate control but not rhythm control, hence, the atria will keep on fibrillating, and the ventricular response will dependent on the implanted permanent pacemaker [34][35][36][37][38][39] .…”

“…In general, several retrospective studies, randomized control studies, and meta-analysis reported beneficial evidence that AVN catheter ablation followed by permanent pacemaker implantation are a valuable palliative therapy for highly symptomatic, drug-refractory AF patients. Many retrospective studies have documented significant acute and long-term improvement in left ventricular function, symptoms, cardiac performance, exercise tolerance, clinical outcomes, and quality of life in selected patients with paroxysmal and persistent drug-refractory AF who have undergone AVN ablation and permanent pacemaker implantation [30][31][32][33][34][35][36][37] .…”

Radiofrequency Energy Modification of the Atrioventricular Junction in Patients with Atrial Fibrillation: Modes of Ventricular Response Under Autonomic Blockade and Long‐Term Effect

“…If pharmacological treatment is unsuccessful in optimizing ventricular rate response, radiofrequency (RF) ablation of the atrioventricular (AV) junction and induction of complete AV block with subsequent implantation of a pacemaker is an effective therapeutic alternative. [9][10][11] The most significant drawback of this therapeutic approach is a lifelong pacemaker dependency. In addition, in a minority of patients, AVN ablation can lead to hemodynamic deterioration together with progression of mitral regurgitation.…”