October 21, 1997Circulation
Assessment of Atrioventricular Junction Ablation and DDDR Mode-Switching Pacemaker Versus Pharmacological Treatment in Patients With Severely Symptomatic Paroxysmal Atrial Fibrillation
Why the study?
Does AV junction ablation and DDDR mode-switching pacemaker implantation improve quality of life and symptoms compared to pharmacological treatment in patients with severely symptomatic, drug-refractory paroxysmal atrial fibrillation?
Population
43 patients with intolerable, recurrent paroxysmal atrial fibrillation of three or more episodes in the…
Comparison
Atrioventricular junction ablation and DDDR… vs Pharmacological treatment
Design
RCT, randomized
Follow-up
6 months
Authors
Discussion
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Implication
Supports AV junction ablation plus pacemaker for QoL gains in refractory paroxysmal AF; extends evidence for this strategy over pharmacotherapy.
Key Points
- To evaluate the efficacy of atrioventricular junction ablation paired with DDDR mode-switching pacemaker implantation compared to pharmacological therapy in patients with severely symptomatic, drug-refractory paroxysmal atrial fibrillation.
- Conducted a multicenter, randomized, 6-month trial in 43 patients suffering from severe paroxysmal atrial fibrillation unresponsive to three or more antiarrhythmic drugs.
- Assigned patients to either atrioventricular junction ablation combined with DDDR mode-switching pacemaker implantation (Abl+Pm) or continued pharmacological therapy.
- Compared to the drug group (n=18), the Abl+Pm group (n=21) showed marked improvements in Living with Heart Failure scores (-51%, P=.0006), palpitations (-71%, P=.0000), effort dyspnea (-36%, P=.04), and fatigue (-51%, P=.02).
- Palpitations resolved completely in 81% of the Abl+Pm group compared to 11% in the drug group (P=.0000).
- Asymptomatic atrial fibrillation recurred in 25% of visits in the Abl+Pm group versus 8% of visits in the drug group (P=.0005), and chronic atrial fibrillation developed in 24% (5/21) versus 0% (0/18), respectively (P=.04).
Structured PICO
Does AV junction ablation and DDDR mode-switching pacemaker implantation improve quality of life and symptoms compared to pharmacological treatment in patients with severely symptomatic, drug-refractory paroxysmal atrial fibrillation?
P
Population
43 patients with intolerable, recurrent paroxysmal atrial fibrillation (AF) of three or more episodes in the previous 6 months not controlled with three or more antiarrhythmic drugs
I
Intervention
Atrioventricular (AV) junction ablation and DDDR mode-switching pacemaker implantation
C
Comparator
Pharmacological treatment
O
Outcome
Quality of life (Living with Heart Failure Questionnaire) and specific symptoms at 6 monthspatient reported
In patients with highly symptomatic, drug-refractory paroxysmal AF, AV junction ablation and pacemaker implantation significantly improves quality of life and symptoms compared to continued pharmacological therapy, though it increases the risk of developing permanent AF.
Cite This Study
Brignole et al. (1997) studied this question.