The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

Weerasooriya, Rukshen; Davis, Michael J.; Powell, Anne; Szili-Török, Tamás; Shah, Chetan; Whalley, David; Kanagaratnam, Logan; Heddle, Bill; Leitch, James; Perks, A.M.; Ferguson, Louise; Bulsara, Max

doi:10.1016/s0735-1097(03)00338-3

Cited by 130 publications

(53 citation statements)

References 16 publications

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“…A report of 350 patients from the Mayo Clinic demonstrated that in patients without underlying cardiac disease, survival at a mean follow-up of 3 years was the same as expected in the general population and as in patients treated with medications for rate control [8]. The AIRCRAFT (Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial) showed that ablation of the AV conducting system improves symptoms in patients who are unable to achieve adequate rate control with medications [9]. A meta-analysis has shown this approach to improve ventricular function, quality of life, exercise duration, and health care use with the same mortality as those treated medically [10].…”

Section: Treatment Av Node Ablation and Permanent Pacingmentioning

confidence: 87%

Device-based therapies for atrial fibrillation

Bruce¹,

Friedman

2005

Curr Treat Options Cardio Med

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Ablation of the atrioventricular conduction system and pacemaker implantation is the preferred procedure for patients with atrial fibrillation (AF) in whom a rate control strategy has been selected but in whom rate-controlling medications are intolerable or ineffective. Selection of standard right ventricular (RV) pacing versus biventricular pacing is individualized, based on the degree and etiology of left ventricular dysfunction. Atrial-based pacing is clearly preferable to ventricular-based pacing in patients with sick sinus syndrome, because it leads to a reduction in the development of AF. Emerging evidence indicates that excess RV pacing is deleterious, increasing AF, heart failure, and possibly mortality. Therefore, physiologic pacing with minimization of RV pacing is desirable. Atrial pacing algorithms that increase the frequency of atrial pacing have shown modest efficacy in the prevention of AF. Use of atrial pacing algorithms is reasonable for patients with a history of AF and standard bradycardia indications for permanent pacing in whom maintenance of sinus rhythm is desirable. Studies assessing novel and multiple site atrial pacing therapies have mixed results, without compelling evidence of clinically important benefit. The exceptions are biatrial and right atrial overdrive pacing immediately after cardiac surgery. Several studies have shown effective suppression of postoperative AF with their use. Device therapy (eg, atrial antitachycardia pacing and defibrillation) for the termination of AF is effective in reducing arrhythmia burden. However, improvement in clinically relevant end points is not established and indications are not clearly defined. If a patient lacks an indication for an implantable cardioverter-defibrillator, we do not offer atrial defibrillation as a treatment option. Atrial arrhythmias may be better prevented by programming to avoid ventricular pacing than by specific atrial interventions.

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Section: Treatment Av Node Ablation and Permanent Pacingmentioning

confidence: 87%

Device-based therapies for atrial fibrillation

Bruce¹,

Friedman

2005

Curr Treat Options Cardio Med

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“…At 1 year, patients who underwent AV junction ablation had a significantly improved quality of life, and cardiac function was not inferior to those in the pharmacologic therapy group [13]. …”

Section: Rate Controlmentioning

confidence: 90%

Pharmacologic management of atrial fibrillation in the elderly: Rate control, rhythm control, and anticoagulation

McClennen

Zimetbaum

2003

Curr Cardiol Rep

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Atrial fibrillation (AF) is the most prevalent major arrhythmia in the elderly. It may lead to significant morbidity and mortality through both primary cardiac effects and thromboembolic complications. It is controversial how aggressive physicians should be in their efforts to maintain normal sinus rhythm. Clearly, elderly patients with hemodynamic impairment or other symptoms of AF should undergo attempts to convert AF and maintain normal sinus rhythm, by means of cardioversion and initiation of antiarrhythmic medications. In patients left in AF, rate control with atrioventricular nodal-slowing agents is appropriate. The use of anticoagulation in the elderly is often complicated by concerns about excessive bleeding or falls in this population; however, evidence strongly supports the need for anticoagulation with close monitoring even in the extreme elderly. Because of the high prevalence of asymptomatic AF and the high burden of thromboembolism in the elderly, even patients ostensibly maintained in normal sinus rhythm should continue systemic anticoagulation in the absence of contraindications.

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“…A steerable radiofrequency (RF) ablation catheter with a 4-, 5-, or 8-mm electrode tip is positioned percutaneously via the right femoral vein at the His bundle region. 4,5 To limit ablation to the AV node, and thus maintain an escape rhythm, the catheter is withdrawn slightly to record approximately equal atrial and ventricular electrogram amplitude and a small His bundle electrogram. Rarely, a left-sided, retrograde, transaortic approach is required, with ablation performed where a large His bundle electrogram is recorded on the septum just below the aortic valve.…”

Section: Methods For Av Node Modification and Ablationmentioning

confidence: 99%

Atrioventricular node modification and ablation for ventricular rate control in atrial fibrillation

Feld

2007

Heart Rhythm

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The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

Abstract: 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.

Cited by 130 publications

References 16 publications

Device-based therapies for atrial fibrillation

Device-based therapies for atrial fibrillation

Pharmacologic management of atrial fibrillation in the elderly: Rate control, rhythm control, and anticoagulation

Atrioventricular node modification and ablation for ventricular rate control in atrial fibrillation

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