Key result
Modified AV junction ablation linked to ~52% lower mortality versus standard ablation in uncontrollable AF.
Why the study?
Standard AV junctional ablation and ventricular pacing for refractory AF can diminish ventricular function and lead to heart failure, prompting the development of a modified ablation technique.
Does a modified form of AV junction ablation reduce pacemaker dependence and mortality in patients with atrial fibrillation and fast ventricular response compared to standard AV ablation?
Does a modified form of AV junction ablation reduce pacemaker dependence and mortality in patients with atrial fibrillation and fast ventricular response compared to standard AV ablation?
Absolute Event Rate: 32% vs 67%
A modified AV junction ablation technique that preserves the AV node and His bundle significantly reduces pacemaker dependence and mortality compared to standard AV ablation in patients with refractory atrial fibrillation.
BACKGROUND: The management of patients with atrial fibrillation and an abnormally fast ventricular response has been through the use of pharmacologic agents. In those cases where rate control cannot be achieved pharmacologically, a standard approach has been atrioventricular (AV) junctional ablation and ventricular pacemaker implantation to achieve a stable ventricular rate. Long-term ventricular pacing has been shown to result in diminished ventricular function that can lead to heart failure. OBJECTIVE: To describe an experimental and clinical study demonstrating a modified form of AV junction ablation. METHODS: Ablation of the slow and fast AV nodal input does not produce AV block. Ablation of the connection between the two induces AV block, leaving the AV node and His bundle intact. RESULTS: Subsequently the escape heart rate is close to normal and responds well to exercise. CONCLUSION: In a clinical study with a 42 month follow-up, the modified procedure resulted in significantly reduced pacemaker dependence and mortality compared to the standard AV ablation procedure.
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Scherlag et al. (2020) conducted a review in Atrial fibrillation (n=76). Modified atrioventricular junctional ablation vs. Standard atrioventricular junctional ablation was evaluated on Mortality. A modified atrioventricular junctional ablation procedure reduced mortality to 32% compared to 67% with standard AV ablation over a 42-month follow-up in patients with uncontrollable atrial fibrillation.
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