Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation

Abstract

Background Although sudden death (SD) is a rare complication after atrioventricular junction (AVJ) ablation and permanent pacemaker implantation, the risk factors leading to this SD remain unknown. The purpose of this study was to investigate SD and its risk factors after ablate‐and‐pace strategy for rate control in atrial fibrillation (AF) patients during long‐term follow‐up. Hypothesis Methods From January 2005 to December 2009, we enrolled into this study 517 AF patients with AVJ ablation and right ventricular pacemaker implantation. Patients were divided into 2 groups, SD and non‐SD. Cox proportional hazards models were used to assess potential risk factors for overall mortality and SD. Results During a mean follow‐up of 25.8 ± 18.6 months (range, 3 days to 63.8 months), 53 patients died (15 with SD). Cox proportional hazards models showed that the presence of congestive heart failure, New York Heart Association functional class, chronic renal failure, and nonsustained ventricular tachycardia were risk factors that predicted overall mortality. For SD, the presence of dilated cardiomyopathy and mitral stenosis were associated risk factors. SD was exclusively seen in patients who had narrow QRS complex or right bundle branch block prior to AVJ ablation and pacemaker implantation; SD was not seen in any patient with preexisting complete left bundle branch block. Conclusions Dilated cardiomyopathy, mitral stenosis, and baseline QRS morphology should be examined as potential risk factors for SD after AVJ ablation and pacemaker implantation.

Bradycardia-induced polymorphic ventricular tachycardia after radiofrequency catheter ablation for right atrial flutter

“…The risk factors for sudden death after AVJ ablation and pacemaker insertion for AF have been investigated. The presence of dilated cardiomyopathy, structural heart disease (particularly mitral stenosis, but also aortic stenosis and aortic regurgitation), New York Heart Association functional class greater than II, preprocedure ventricular arrhythmia, diabetes, and chronic obstructive pulmonary disease were all associated risk factors 5, 9, 10. Sudden death was exclusively seen in patients who had narrow QRS complex or right bundle branch block prior to AVJ ablation but not in patients with preexisting left bundle branch block 9 …”

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure

“…In addition, pacinginduced changes in QTc and QT dispersion may be related to the risk of sudden cardiac death in patients undergoing CRT [77,78] . Nowadays, sudden cardiac death is not a subject of concern in the "ablate and pace" approach [79,80] [Figure 5]. The 1 year total mortality is 6.3% and the rate of sudden cardiac death is only 2%, which is similar to that of control patients with atrial fibrillation who remain on drug therapy [45,66] .…”