Atrioventricular junction ablation and pacing did not significantly differ from pharmacologic rate control in left ventricular ejection fraction (54% vs 61%, p=ns) or exercise duration at 12 months.
RCT (n=99)
randomized
Yes
Does atrioventricular junction ablation and pacing improve cardiac function and exercise tolerance in patients with mild to moderately symptomatic permanent atrial fibrillation compared to pharmacologic rate control?
In patients with mild to moderately symptomatic permanent AF, atrioventricular junction ablation and pacing did not worsen cardiac function compared to pharmacologic rate control and resulted in improved quality of life.
Absolute Event Rate: 54% vs 61%
p-value: p=ns
OBJECTIVES: The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial was a multicenter trial of atrioventricular junction ablation and pacing (AVJAP) compared with pharmacologic ventricular rate control (medication MED) in patients with mild to moderately symptomatic permanent atrial fibrillation (AF). BACKGROUND: There have been very few prospective randomized trials, undertaken in highly symptomatic patients, comparing AVJAP with pharmacologic methods of ventricular rate control for patients with permanent AF. METHODS: There were 99 patients (70 men, mean age 68 +/- 8.6 years) at five centers. Forty-nine patients were randomized to AVJAP while 50 patients were randomized to pharmacologic control. The primary end point was cardiac function measured by echocardiography and exercise tolerance. The secondary end points were ventricular rate control, evaluated by 24-h ambulatory electrocardiographic monitoring, and quality of life. Data were collected at randomization and then at one month, six months, and 12 months post-randomization. RESULTS: At 12 months follow-up there was no significant difference in left ventricular ejection fraction (AVJAP: 54 +/- 17%; MED: 61 +/- 13% p = ns) or exercise duration on treadmill testing (AVJAP: 4.1 +/- 2 min; MED: 4.6 +/- 2 min p = ns); however, the peak ventricular rate was lower in the AVJAP group during exercise (112 +/- 17 beats/min vs. 153 +/- 36 beats/min, p < 0.05) and activities of daily life (117 +/- 16 beats/min vs. 152 +/- 37 beats/min, p < 0.05). The CAST quality-of-life questionnaire revealed that patients in the AVJAP group had fewer symptoms at six months (p = 0.003) and at 12 months (p = 0.004). The observed relative risk reduction in symptoms at 12 months was 18%. Global subjective semiquantitative measurement of quality of life using the "ladder of life" revealed that the AVJAP group reported a 6% better quality of life at six months (p = 0.011). CONCLUSIONS: In this trial, AVJAP for patients with mild to moderately symptomatic permanent AF did not worsen cardiac function during long-term follow-up, and quality of life was improved.
Weerasooriya et al. (2003) conducted an RCT in mild to moderately symptomatic permanent atrial fibrillation (AF) (n=99). Atrioventricular junction ablation and pacing (AVJAP) vs. Pharmacologic ventricular rate control (medication) was evaluated on Cardiac function measured by echocardiography (left ventricular ejection fraction) and exercise tolerance (p=ns). Atrioventricular junction ablation and pacing did not significantly differ from pharmacologic rate control in left ventricular ejection fraction (54% vs 61%, p=ns) or exercise duration at 12 months.