Key result
Hypothetical ablation of multiple AV nodal pathways estimates a ~26 bpm reduction in rapid permanent AF.
Cross-Sectional (n=250)
Mean Difference: 26
p-value: p=<0.01
Multiple AV nodal pathways are suspected in 39% of patients with permanent atrial fibrillation, and hypothetical ablation of supernumerary pathways could significantly reduce heart rate in a subset of these patients.
Should not yet change rate-control practice in permanent AF; leaves open potential benefit of targeting multiple AV nodal pathways.
Two or more peaks on the 24-hour electrocardiogram (ECG) RR interval histogram of patients with atrial fibrillation suggests the presence multiple AV nodal pathways. The prevalence of multiple AV nodal pathways in this population is unknown. The study included 250 patients with permanent atrial fibrillation during 24-hour ECG. The number of peaks on the RR interval histogram was measured in each patient. A single peak was present in 153 patients (61%), 80 patients (32%) had two peaks, 13 patients (5%) had three, and 4 patients (2%) had four peaks. Among the 97 patients (39%) with > 1 AV nodal pathway, the estimated mean heart rate reduction by hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods was 16 beats/min, from 82 to 65 beats/min. Among the overall population, 16 patients (6%) with > 1 AV nodal pathway had a mean heart rate > 100 beats/min. In this subgroup, modulation of AV node conduction by hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods yielded an estimated reduction in mean heart rate of 26 +/- 15 beats/min, from 110 +/- 9 beats/min to 84 +/- 14 beats/min (P < 0.01), a 23% decrease. The presence of > 1 AV nodal pathway was suspected in 39% of all patients with permanent atrial fibrillation. The hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods resulted in a clinically significant reduction in heart rate in 6% of patients in this population.
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Weismüller et al. (2000) conducted a cross-sectional in Permanent atrial fibrillation (n=250). Presence of >1 AV nodal pathway vs. Single AV nodal pathway was evaluated on Estimated reduction in mean heart rate by hypothetical ablation in patients with >1 AV nodal pathway and baseline HR >100 beats/min (MD 26 beats/min, p=<0.01). Multiple AV nodal pathways were suspected in 39% of patients with permanent AF; in those with HR >100 bpm, hypothetical ablation yielded an estimated HR reduction of 26 beats/min (P<0.01).
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