Key result
Ablate and pace therapy for atrial fibrillation caused pacemaker dependence in 42% of patients, with no significant differences in clinical events compared to non-dependent patients.
Why the study?
Does pacemaker dependence affect clinical outcomes in patients undergoing ablate and pace therapy for atrial fibrillation?
Cohort (n=163)
Does pacemaker dependence affect clinical outcomes in patients undergoing ablate and pace therapy for atrial fibrillation?
Ablate and pace therapy is safe and effective for AF with uncontrolled ventricular rate, and while 42% become pacemaker-dependent, this does not adversely affect long-term clinical outcomes.
Answers are grounded in this paper and cite their sources.
Pacemaker dependence after ablate-and-pace was not linked to worse events; leaves open need for randomized outcome confirmation in AF.
AIMS: In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction. METHODS AND RESULTS: One-hundred and sixty-three patients (71 men; mean age 71 +/- 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life. CONCLUSION: This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.
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Occhetta et al. (2007) conducted a cohort in Atrial fibrillation with uncontrolled ventricular rate (n=163). Ablate and pace therapy was evaluated on Pacemaker dependence. Ablate and pace therapy for atrial fibrillation caused pacemaker dependence in 42% of patients, with no significant differences in clinical events compared to non-dependent patients.
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