Incidence of Sudden Death After Radiofrequency Ablation of the Atrioventricular Junction for Atrial Fibrillation

Darpö, Börje; Walfridsson, Håkan; Aunes, Maria; Bergfeldt, Lennart; Edvardsson, Nils; Linde, Cecilia; Lurje, Leon; Linden, Marie van der; Rosenqvist, Mårten

doi:10.1016/s0002-9149(97)00635-8

Cited by 59 publications

(42 citation statements)

References 13 publications

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“…40,42 Proposed mechanisms include exaggerated repolarization abnormalities after heart rate control in patients with prior tachycardia 66 and absence of an escape rhythm in the event of pacemaker failure. 49,67 The reported incidence of SCD after AVNA has ranged between 1-11% in retrospective studies, 32,40,42,51,64 with LVEF Ͻ45%, 42 coronary artery disease, and structural heart disease 51 identified as independent risk factors. Of note, studies finding independent associations between systolic dysfunction and SCD 14,42 were published before the standard use of implantable cardioverter-defibrillator as primary prophylaxis in this population.…”

Section: Discussionmentioning

confidence: 99%

Atrioventricular Nodal Ablation in Atrial Fibrillation

Chatterjee

Upadhyay

Ellenbogen

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background-In the treatment of patients with refractory atrial fibrillation (AF), the safety and efficacy of atrioventricular nodal ablation (AVNA) versus pharmacotherapy alone remains unclear. Additionally, the impact of AVNA in patients with reduced systolic function is of growing interest. Methods and Results-A total of 5 randomized or prospective trials were included for efficacy review (314 patients), 11 studies for effectiveness review (810 patients), and 47 studies for safety review (5632 patients). All-cause mortality was similar between AVNA and medical therapy (3.1% versus 3.3%; relative risk ratio, 1.05; 95% confidence interval [CI], 0.29 -3.85). There was no significant difference in exercise duration or ejection fraction (EF) with AVNA relative to pharmacotherapy. In subgroup analysis, patients with baseline systolic dysfunction (116 patients; mean EF, 44%) showed significant relative improvement in EF after AVNA (ϩ4% greater; 95% CI, 3.11-4.89). In pooled observational analysis, AVNA was also associated with significant improvement in EF only in patients with systolic dysfunction (ϩ7.44%; 95% CI, 5.4 -9.5). The incidence of procedure-related mortality (0.27%) and malignant arrhythmia (0.57%) was low. At mean follow-up of 26.5 months, the incidence of sudden cardiac death after AVNA was 2.1%. There was significant heterogeneity in quality-of-life scales used; compared with pharmacotherapy, AVNA was associated with significant improvement in several symptoms (palpitations, dyspnea). Conclusions-In the management of refractory AF, AVNA is associated with improvement in symptoms and quality of life, with a low incidence of procedure morbidity. In patients with reduced systolic function, AVNA demonstrates small but significantly improved echocardiographic outcomes relative to medical therapy alone. (Circ Arrhythm Electrophysiol. 2012;5:68-76.)

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Section: Discussionmentioning

confidence: 99%

Atrioventricular Nodal Ablation in Atrial Fibrillation

Chatterjee

Upadhyay

Ellenbogen

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…There is continuing concern that AV junctional ablation may be linked to subsequent sudden death [3,8] . Three mechanisms are put forward.…”

Section: Discussionmentioning

confidence: 99%

Ablation of the atrioventricular junction

Marshall

Griffith

1999

EP Europace

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Atrioventricular junctional ablation is an attempt to interrupt conduction from the atrium to the ventricle using radiofrequency energy. The objective is to ablate the compact atrioventricular node as high as possible, leaving a stable ventricular escape rhythm. The compact node is identified in part by its relation to His recordings and partly through the known anatomy. In our series of 115 consecutive patients, atrioventricular block was achieved from the right side in 96% of patients and the remainder had the atrioventricular node ablated from the left side. Long-term success, i.e. complete heart block, was achieved in all patients. Complications in this and other series are rare, but there remains concern about sudden death in these patients. (Europace 1999; 1: 26-29)

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“…However, sudden death has continued to be reported in the era of radio frequency ablation of the AV junction. Darpo et al [36] examined 31 deaths occurring in 220 patients following radio frequency AV nodal ablation in a national registry. Eleven of these deaths were sudden and in all there was either antemortem or post-mortem evidence of structural heart disease.…”

Section: Sudden Death Following Av Junction Ablationmentioning

confidence: 99%

Atrioventricular junction ablation and pacemaker implantation for heart failure associated with atrial fibrillation: potential issues and therapies in the setting of acute heart failure syndrome

Rubenstein

Roth

2011

Heart Fail Rev

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Atrial fibrillation is the most common arrhythmia and is especially clinically important in patients with heart failure. Prolonged atrial fibrillation with high ventricular rate response may lead to development or worsening of left ventricular function. If adequate heart rate control cannot be obtained medically, often patients will undergo pacemaker implant and catheter ablation of the atrioventricular junction. This intervention can have profound effects on the course of heart failure. This article reviews the technique, complications, outcome data, and alternatives to this management strategy. The potential role of this therapeutic modality in those hospitalized with acute heart failure syndromes is discussed.

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Incidence of Sudden Death After Radiofrequency Ablation of the Atrioventricular Junction for Atrial Fibrillation

Cited by 59 publications

References 13 publications

Atrioventricular Nodal Ablation in Atrial Fibrillation

Atrioventricular Nodal Ablation in Atrial Fibrillation

Ablation of the atrioventricular junction

Atrioventricular junction ablation and pacemaker implantation for heart failure associated with atrial fibrillation: potential issues and therapies in the setting of acute heart failure syndrome

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