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

Marshall, Howard; Harris, Z. I.; Griffith, Michael; Holder, Roger; Gammage, Michael D.

doi:10.1161/01.cir.99.12.1587

Cited by 95 publications

(59 citation statements)

References 25 publications

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“…363,387,388,[792][793][794] Baseline quality-of-life scores are generally lower for patients with AF or atrial flutter than for those undergoing ablation for other arrhythmias. 795 A meta-analysis of 10 studies of patients with AF 389 found improvement in both symptoms and quality-of-life scores after ablation and pacing.…”

Section: Fuster Et Al Acc/aha/esc Practice Guidelines E319mentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,883

589

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Section: Fuster Et Al Acc/aha/esc Practice Guidelines E319mentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,883

589

View full text Add to dashboard Cite

“…Multiple clinical studies have demonstrated improved quality of life following atrioventricular node (AVN) ablation and permanent right ventricular (RV) pacing in patients with symptomatic atrial fibrillation (AF) refractory to optimal medical therapy 1, 2, 3, 4. However, several studies performed over the last decade have demonstrated that conventional long‐term RV apical pacing can increase the risk of death and heart failure hospitalization 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Huang

et al. 2017

JAHA

192

122

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BackgroundClinical benefits from His bundle pacing (HBP) in heart failure patients with preserved and reduced left ventricular ejection fraction are still inconclusive. This study evaluated clinical outcomes of permanent HBP in atrial fibrillation patients with narrow QRS who underwent atrioventricular node ablation for heart failure symptoms despite rate control by medication.Methods and ResultsThe study enrolled 52 consecutive heart failure patients who underwent attempted atrioventricular node ablation and HBP for symptomatic atrial fibrillation. Echocardiographic left ventricular ejection fraction and left ventricular end‐diastolic dimension, New York Heart Association classification and use of diuretics for heart failure were assessed during follow‐up visits after permanent HBP. Of 52 patients, 42 patients (80.8%) received permanent HBP and atrioventricular node ablation with a median 20‐month follow‐up. There was no significant change between native and paced QRS duration (107.1±25.8 versus 105.3±23.9 milliseconds, P=0.07). Left ventricular end‐diastolic dimension decreased from the baseline (P<0.001), and left ventricular ejection fraction increased from baseline (P<0.001) in patients with a greater improvement in heart failure with reduced ejection fraction patients (N=20) than in heart failure with preserved ejection fraction patients (N=22). New York Heart Association classification improved from a baseline 2.9±0.6 to 1.4±0.4 after HBP in heart failure with reduced ejection fraction patients and from a baseline 2.7±0.6 to 1.4±0.5 after HBP in heart failure with preserved ejection fraction patients. After 1 year of HBP, the numbers of patients who used diuretics for heart failure decreased significantly (P<0.001) when compared to the baseline diuretics use.ConclusionsPermanent HBP post–atrioventricular node ablation significantly improved echocardiographic measurements and New York Heart Association classification and reduced diuretics use for heart failure management in atrial fibrillation patients with narrow QRS who suffered from heart failure with preserved or reduced ejection fraction.

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“…The initial search yielded 2659 results, of which (1) 5 met our inclusion criteria for efficacy analysis of AVNA and pharmacotherapy, [21][22][23][24][25] (2) 11 met inclusion criteria for effectiveness analysis, 12,16,17,26 -33 and (3) 47 met inclusion criteria for safety analysis (Figure 1 and online-only Data Supplement Appendix Table 1). 11,12,14,16,17, The studies comparing AVNA and pharmacotherapy included 314 patients, of whom 161 underwent AVNA and 153 received pharmacotherapy.…”

Section: Search Resultsmentioning

confidence: 99%

“…␤-Blocker use was not consistently documented. Of the other 3 efficacy studies, 2 reported a mean EF (weighted mean EF, 57Ϯ4%) 22,25 and the authors of the third study 21 stated that the "majority had normal LV function at the outset." Four of the 5 efficacy studies comparing AVNA with pharmacotherapy were randomized.…”

Section: Search Resultsmentioning

confidence: 99%

See 1 more Smart Citation

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

Abstract: Background-Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy.

Cited by 95 publications

References 25 publications

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Atrioventricular Nodal Ablation in Atrial Fibrillation

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