Long-term follow-up of patients after transcatheter direct current ablation of the atrioventricular junction

Abstract

The long-term follow-up study (41 +/- 23 months) of 47 patients undergoing direct current ablation because of drug-resistant supraventricular arrhythmias is reported. Significant early complications occurred in four patients and included hypotension, pericarditis, nonsustained polymorphic ventricular tachycardia and one sudden death. In 42 patients (86%), complete atrioventricular (AV) block was initially achieved. During the follow-up period, AV conduction resumed in 2 of these 42 patients. Of the seven patients in whom ablation was unsuccessful, two developed late complete AV block and three had symptomatic improvement. An improved activity level was reported among 83% of the patients with successful ablation. Health care utilization manifest as the number of hospital admissions per year before and after ablation decreased significantly after ablation (2.4 +/- 2.0 versus 0.3 +/- 0.5, p less than 0.001). Echocardiographic evaluation in five patients with a depressed left ventricular ejection fraction (27 +/- 7%) before ablation showed a significant increase (45 +/- 14%, p less than 0.05) after an average follow-up period of 31 months. New onset of congestive heart failure occurred after ablation in four patients, of whom two had no structural heart disease. The total mortality rate, including the one patient with sudden death, was 17% and was significantly higher among patients with underlying structural heart disease. Transcatheter direct current ablation is an effective treatment in patients with drug-resistant supraventricular tachycardia, providing a beneficial long-term outcome including an improved quality of life and a decrease in health care utilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Failure and Sudden Death in Patients With Tachycardia-Induced Cardiomyopathy and Recurrent Tachycardia

“…Left ventricular systolic function, measured by left ventricular ejection fraction (LVEF), improves or normalizes and symptoms resolve if tachycardia is controlled with medication 1,2 or ablation. [3][4][5][6][7][8][9][10][11] TIC has been described in patients of all ages, in heart transplant patients, 12 and even in utero. 13 Rhythms causing TIC include atrial fibrillation, 14 -16 atrial flutter, 17 supraventricular tachycardia, 3,4,8,10,12,18 ventricular tachycardia, [5][6][7]19,20 fascicular tachycardia, 2 ventricular ectopy, 21 and even persistent rapid DDD pacing.…”

Prospective Randomized Study of Ablation and Pacing Versus Medical Therapy for Paroxysmal Atrial Fibrillation

“…Of the studies to date, most have been uncontrolled, retrospective, or have not distinguished between chronic AF and PAF. [3][4][5][6][7][8][9] The only prospective study comparing medical treatment for PAF with ablation and pacing suggested superiority for the latter but did not assess the optimum pacing mode 10 ; because both VVIR 4 and DDDR/MS 3 pacing have been shown to be effective, an assessment of pacing mode is required. Similarly, no study has assessed whether the modeswitching algorithm used affects the efficacy of ablation and pacing.…”

Atrial fibrillation and quality of life after pacemaker implantation for sick sinus syndrome: Data from the Mode Selection Trial (MOST)

“…17,19 Studies in highly symptomatic patients with AF undergoing atrioventricular node ablation and often subsequent pacemaker placement also reported marked improvement in QOL in these selected patient populations. [20][21][22][23] However, in the older, less selected population enrolled in the AFFIRM QOL substudy, QOL was comparable between rate and rhythm control strategies and was also similar in SR versus AF, 24,25 suggesting that effects on QOL associated with AF were quite modest in an older, medically managed population.…”