What is the clinical evidence from this study?

Study design: Observational. Population: Drug-refractory atrial fibrillation (n=55). Intervention: Long-term right ventricular pacing vs. Baseline. Primary outcome: Development of left ventricular dyssynchrony.

What question did this study set out to answer?

To assess the long-term impact of right ventricular pacing on left ventricular dyssynchrony, cardiac function, and heart failure symptoms in patients following atrioventricular node ablation.

May 9, 2026Journal of the American College of Cardiology

Right Ventricular Pacing Can Induce Ventricular Dyssynchrony in Patients With Atrial Fibrillation After Atrioventricular Node Ablation

Q: What are the key findings of this study?

Long-term right ventricular pacing after atrioventricular node ablation induced left ventricular dyssynchrony in 49% of patients, which was associated with worsened heart failure symptoms.

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Key result

Long-term RVP induces LV dyssynchrony in ~49% of patients, worsening heart failure symptoms.

n=55

Why the study?

The effects of long-term right ventricular pacing on left ventricular dyssynchrony, function, and heart failure symptoms in patients with atrial fibrillation after AV node ablation were not well characterized.

Does long-term right ventricular pacing induce left ventricular dyssynchrony and worsen heart failure symptoms in patients with atrial fibrillation after atrioventricular node ablation?

Key Points

To assess the long-term impact of right ventricular pacing on left ventricular dyssynchrony, cardiac function, and heart failure symptoms in patients following atrioventricular node ablation.
Evaluated 55 patients with drug-refractory atrial fibrillation undergoing atrioventricular node ablation and permanent pacemaker implantation.
Assessed left ventricular dyssynchrony using M-mode echocardiography and tissue Doppler imaging, alongside left ventricular function, volumes, and NYHA functional class at baseline and after a mean follow-up of 3.8 ± 1.7 years.
Long-term right ventricular pacing induced left ventricular dyssynchrony in 49% of patients (27 of 55).
Patients developing dyssynchrony demonstrated worsening heart failure symptoms with NYHA class increasing from 1.8 ± 0.6 to 2.2 ± 0.7 (p < 0.05), decreased left ventricular ejection fraction from 48 ± 7% to 43 ± 7% (p < 0.05), and increased end-diastolic volume from 116 ± 39 ml to 130 ± 52 ml (p < 0.05).
Patients who did not develop left ventricular dyssynchrony experienced no significant deterioration in heart failure symptoms, left ventricular function, or cardiac volumes.

Study Design

Type

Observational (n=55)

Structured PICO

Does long-term right ventricular pacing induce left ventricular dyssynchrony and worsen heart failure symptoms in patients with atrial fibrillation after atrioventricular node ablation?

Population

55 patients with drug-refractory atrial fibrillation treated with atrioventricular node ablation and pacemaker implantation, followed for a mean of 3.8 years.

Exposure

Long-term right ventricular (RV) pacing

Outcome

Left ventricular (LV) dyssynchrony (by M-mode echocardiography and tissue Doppler imaging), LV function, LV volumes, and functional status (heart failure symptoms)surrogate

Implication

Long-term right ventricular pacing after AV node ablation for atrial fibrillation induces LV dyssynchrony in nearly half of patients, leading to deterioration in systolic function and worsening heart failure symptoms.

Abstract

OBJECTIVES: This study was designed to assess the effects of long-term right ventricular (RV) pacing on left ventricular (LV) dyssynchrony, LV function, and heart failure symptoms. BACKGROUND: Atrioventricular (AV) node ablation and subsequent long-term RV pacing is a well-established treatment option in patients with atrial fibrillation (AF). METHODS: In 55 patients with drug-refractory AF, AV node ablation and implantation of a pacemaker was performed. At baseline and after a mean of 3.8 +/- 1.7 years, LV dyssynchrony (by M-mode echocardiography and tissue Doppler imaging), LV function, and volumes and functional status were assessed. RESULTS: After long-term RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, these patients worsened in heart failure symptoms (New York Heart Association functional class increased from 1.8 +/- 0.6 to 2.2 +/- 0.7, p < 0.05), with a decrease in LV ejection fraction (from 48 +/- 7% to 43 +/- 7%, p < 0.05) and an increase in LV end-diastolic volume (from 116 +/- 39 ml to 130 +/- 52 ml, p < 0.05). Conversely, patients without LV dyssynchrony did not deteriorate in heart failure symptoms, LV function, or LV volumes. CONCLUSIONS: Long-term RV pacing can induce LV dyssynchrony in almost 50% of patients treated with AV node ablation for chronic AF. The development of LV dyssynchrony was associated with deterioration in heart failure symptoms, systolic LV function, and LV dilatation.

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Cite This Study

Tops et al. (2006) conducted an observational in Drug-refractory atrial fibrillation (n=55). Long-term right ventricular pacing vs. Baseline was evaluated on Development of left ventricular dyssynchrony. Long-term right ventricular pacing after atrioventricular node ablation induced left ventricular dyssynchrony in 49% of patients, which was associated with worsened heart failure symptoms.

synapsesocial.com/papers/69ff50641bea6faad8cdadc5 https://doi.org/10.1016/j.jacc.2006.05.072