Atrioventricular node ablation in patients with atrial fibrillation significantly increased global left ventricular ejection fraction from 48.9% to 54.1% and decreased hospital admissions over two years.
Observational (n=104)
Yes
Does catheter ablation of the atrioventricular node and pacemaker implantation improve LVEF, functional status, and hospital admissions in patients with symptomatic atrial fibrillation?
While AV node ablation and pacing generally improves LVEF and reduces hospitalizations in refractory AF, patients with baseline LVEF <50% or prior mitral valve replacement are at high risk for LVEF deterioration and may require biventricular pacing.
Absolute Event Rate: 54.1% vs 48.9%
p-value: p=<0.001
INTRODUCTION: At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome. METHODS: 104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 ± 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF). RESULTS: After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation. CONCLUSIONS: AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the "ablate and pace" strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered." Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.
Rodríguez‐Mañero et al. (Wed,) conducted a observational in Atrial Fibrillation (n=104). Atrioventricular node ablation (AVNA) and pacemaker implantation vs. Baseline was evaluated on Global left ventricular ejection fraction (LVEF) (p=<0.001). Atrioventricular node ablation in patients with atrial fibrillation significantly increased global left ventricular ejection fraction from 48.9% to 54.1% and decreased hospital admissions over two years.