1
|
Martínez-Sande JL, Rodríguez-Mañero M, García-Seara J, Lago R, González-Melchor L, Kreidieh B, Iacopino S, De Regibus V, De Greef Y, Bruno S, Curnis A, Sieira J, Chierchia GB, Brugada P, González-Juanatey JR, de Asmundis C. Acute and long-term outcomes of simultaneous atrioventricular node ablation and leadless pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1484-1490. [PMID: 30221378 DOI: 10.1111/pace.13496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/21/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
AIMS Leadless pacemaker (LDP) allows implantation using a femoral approach. This access could be utilized for conventional atrioventricular nodal ablation (AVNA). It could facilitate unifying the two procedural components. Data regarding its feasibility and long-term outcomes remain lacking. We aim to evaluate the feasibility and long-term outcomes of sequential LDP and AVNA. METHODS Prospective, observational multicenter study including consecutive patients with indication for single-chamber pacemaker placement. In those with additional indication for AVNA, ablation was performed immediately after the LPD through the same sheath. RESULTS A total of 137 patients were included. Mean age was 77.9 ± 10.5 years; 74 (54%) were men. Immediately following LDP implantation, 27 patients (19.7%) underwent concurrent AVNA. There were six (5.5%) complications in patients referred for LDP procedures and three (11%) in those who underwent a combined approach. None of these complications were solely attributable to the added AVNA component. No mechanical dislodgement, electrical damage to any device, or electromagnetic interference ever took place. During a mean follow-up period of 123 ± 48 days, three patients (3.6%) died of noncardiovascular causes. The remaining population stayed alive without significant arrhythmias. There were no relevant differences with regard to sensing and pacing thresholds between patients in the two groups. CONCLUSIONS AVNA can safely be performed immediately following LDP. A combined approach obviates the need for additional vascular access and optimizes feasibility and comfort for patients and healthcare providers. It offers an acceptable safety and efficacy profile, both acutely and upon intermediate-term follow-up.
Collapse
Affiliation(s)
- José Luis Martínez-Sande
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Moisés Rodríguez-Mañero
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Javier García-Seara
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ramón Lago
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Laila González-Melchor
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Bahij Kreidieh
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Saverio Iacopino
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Valentina De Regibus
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | | | - Antonio Curnis
- Division of Cardiology, Spedali Civili Hospital Università degli Studi di Brescia, Brescia, Italy
| | - Juan Sieira
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - José Ramón González-Juanatey
- Electrophysiology Unit, Hospital Clínico Universitario de Santiago de Compostela, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Universitair Ziekenhuis Brussel, Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
2
|
Abstract
Atrioventricular junction (AVJ) ablation is an effective therapy in patients with symptomatic atrial fibrillation who are intolerant to or unsuccessfully managed with rhythm control or medical rate control strategies. A drawback is that the procedure mandates a pacing system. Overall, the safety and efficacy of AVJ ablation is high with a majority of the patients reporting significant improvement in symptoms and quality-of-life measures. Risk of sudden cardiac death after device implantation is low, especially with an appropriate postprocedure pacing rate. Mortality benefit with AVJ ablation has been shown in patients with heart failure and cardiac resynchronization therapy devices.
Collapse
Affiliation(s)
- Dilesh Patel
- Electrophysiology Section, Division of Cardiology, Ross Heart Hospital, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, USA
| | - Emile G Daoud
- Electrophysiology Section, Division of Cardiology, Ross Heart Hospital, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, USA; Internal Medicine, Wexner Medical Center at The Ohio State University, 473 West 12th Avenue, DHLRI, Suite 200, Columbus, OH 43210, USA.
| |
Collapse
|
3
|
Akerström F, Mañero MR, Pachón M, Puchol A, López XAF, Sande LM, Valderrábano M, Arias MA. Atrioventricular Junction Ablation In Atrial Fibrillation: Choosing The Right Patient And Pacing Device. J Atr Fibrillation 2015; 8:1253. [PMID: 27957188 DOI: 10.4022/jafib.1253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 07/14/2015] [Accepted: 07/19/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is not possible in a large proportion of AF patients, who therefore are subject to a rate control strategy only. Nonetheless, in some of these patients pharmacological rate control may be ineffective, often leaving the patient highly symptomatic and at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF). Catheter ablation of the atrioventricular junction (AVJ) with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In patients with reduced ventricular function, cardiac resynchronization therapy (CRT) should be considered over right ventricular apical (RVA) pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.
Collapse
Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Moisés Rodríguez Mañero
- Cardiac Electrophysiology, Department of Cardiology. Methodist DeBakey Heart and Vascular Center and Methodist Hospital Research Institute, The Methodist Hospital, Houston, Texas
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Xesús Alberte Fernández López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain
| | - Luis Martínez Sande
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Universitario Santiago de Compostela, Spain
| | - Miguel Valderrábano
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| |
Collapse
|
4
|
|
5
|
Rodríguez-Mañero M, Pujol Salvador C, Martínez-Sande L, de Asmundis C, Chierchia GB, Macías Gallego A, A Fernández-López X, José Gavira-Gómez J, García-Seara J, Calvo N, Brugada P, González-Juanatey JR, García-Bolao I. Two-Year Follow-up in Atrial Fibrillation Patients Referred for Catheter Ablation of the Atrioventricular Node. J Atr Fibrillation 2014; 6:911. [PMID: 27957033 DOI: 10.4022/jafib.911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome. METHODS 104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 ± 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF). RESULTS After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation. CONCLUSIONS AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the "ablate and pace" strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered." Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.
Collapse
Affiliation(s)
| | | | - Luis Martínez-Sande
- Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium
| | | | | | | | | | - Javier García-Seara
- Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain
| | - Naira Calvo
- Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain
| | - Pedro Brugada
- Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium
| | | | | |
Collapse
|
6
|
Abstract
Biventricular pacing has been an exciting recent advance in the management of drug-refractory heart failure. This new therapy has evolved as much from necessity as scientific observation, since benefits derived from pharmacotherapy currently appear to have reached their peak. Clinical trials of biventricular pacing are establishing morbidity and mortality benefits in heart failure. New challenges in the use of these pacemakers are now arising. These include the accurate diagnosis of ventricular dyssynchrony and, hence, potential responders to the refinement of implantation of the left ventricular lead to the appropriate dyssynchronous ventricular area and optimization of pacemaker programming. This review gives a general overview of the principles and the current evidence for the use of biventricular pacemakers in the treatment of heart failure. In addition, a discussion of current research and future projects is included.
Collapse
Affiliation(s)
- Paul A Gould
- Wynn Department of Metabolic Cardiology, Baker Heart Research Institute, PO Box 6492, Melbourne, Victoria 8008, Australia.
| | | | | |
Collapse
|
7
|
Hoffmayer KS, Scheinman M. Current role of atrioventricular junction (AVJ) ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:257-65. [PMID: 23078186 DOI: 10.1111/pace.12022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/29/2012] [Accepted: 08/27/2012] [Indexed: 11/28/2022]
Abstract
Atrioventricular junction ablation with permanent pacemaker insertion is a highly effective treatment approach in patients with atrial fibrillation that is resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. This effect likely reflects reversal of rapid ventricular rates and regularizing ventricular rates. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular node ablation. The limitations of this approach include continued need for anticoagulation and lifelong pacemaker therapy.
Collapse
Affiliation(s)
- Kurt S Hoffmayer
- Division of Cardiac Electrophysiology, San Francisco, California, USA
| | | |
Collapse
|
8
|
Abstract
Atrial fibrillation (AF) and heart failure (HF) are common and interrelated conditions, each promoting the other, and both associated with increased mortality. HF leads to structural and electrical atrial remodeling, thus creating the basis for the development and perpetuation of AF; and AF may lead to hemodynamic deterioration and the development of tachycardia-mediated cardiomyopathy. Stroke prevention by antithrombotic therapy is crucial in patients with AF and HF. Of the 2 principal therapeutic strategies to treat AF, rate control and rhythm control, neither has been shown to be superior to the other in terms of survival, despite better survival in patients with sinus rhythm compared with those in AF. Antiarrhythmic drug toxicity and poor efficacy are concerns. Catheter ablation of AF can establish sinus rhythm without the risks of antiarrhythmic drug therapy, but has important procedural risks, and data from randomized trials showing a survival benefit of this treatment strategy are still lacking. In intractable cases, ablation of the atrioventricular junction and placement of a permanent pacemaker is a treatment alternative; and biventricular pacing may prevent or reduce the negative consequences of chronic right ventricular pacing.
Collapse
|
9
|
Stevenson WG, Tedrow UB, Seiler J. Atrial Fibrillation and Heart Failure. J Atr Fibrillation 2008; 1:101. [PMID: 28496583 DOI: 10.4022/jafib.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 07/11/2008] [Accepted: 07/14/2008] [Indexed: 02/02/2023]
Abstract
Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.
Collapse
Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Usha B Tedrow
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| | - Jens Seiler
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Vanerio G, Vidal JL, Fernández Banizi P, Banina Aguerre D, Viana P, Tejada J. Medium- and long-term survival after pacemaker implant: Improved survival with right ventricular outflow tract pacing. J Interv Card Electrophysiol 2008; 21:195-201. [DOI: 10.1007/s10840-008-9238-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/29/2008] [Indexed: 11/29/2022]
|
11
|
Cardiac resynchronization therapy in the setting of permanent atrial fibrillation and heart failure. Curr Opin Cardiol 2008; 23:9-15. [DOI: 10.1097/hco.0b013e3282f303ff] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Abstract
Atrial fibrillation is a marker for worse outcomes in patients with heart failure and requires careful, individualized management. Anticoagulation and rate control are important. Routine use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation for maintaining sinus rhythm is feasible for some patients, but further studies are needed to define the risks and benefits. A role remains for AV junction ablation and pacing, with consideration of biventricular pacing to prevent dyssynchrony induced by chronic right ventricular pacing. Ongoing trials will continue to define the risks and benefits as these therapies evolve.
Collapse
Affiliation(s)
- William G Stevenson
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | |
Collapse
|
13
|
Dilaveris P, Pantazis A, Giannopoulos G, Synetos A, Gialafos J, Stefanadis C. Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick? ACTA ACUST UNITED AC 2006; 8:352-7. [PMID: 16635995 DOI: 10.1093/europace/eul015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Dyssynchrony imposed on ventricular function by right ventricular (RV) apical pacing may lead in some cases to worsening or appearance of heart failure (HF) symptoms. This is a result of an altered pattern of activation, leading to several histological and functional adjustments of the left ventricle, including inhomogeneous thickening of the ventricular myocardium and myofibrillar disarray, fibrosis, disturbances in ion-handling protein expression, myocardial perfusion defects, alterations in sympathetic tone and mitral regurgitation. Studies of mid- and long-term effects of RV apical pacing on left ventricular (LV) function have demonstrated a progressive decline in ejection fraction and other indices of LV functional competence. Upgrading RV pacing systems to biventricular resynchronization modalities is a theoretically promising option for paced patients with worsening HF. The potentially favourable effect of upgrading on LV functional indices and patient clinical status has been demonstrated in few, non-randomized trials. Apart from the scantiness of existing clinical data, issues concerning technical aspects of the procedure and selection of eligible patients are raised. Is pacing-induced dyssynchrony equivalent to the indigenous dyssynchrony in unpaced patients with HF? What selection criteria should be applied in order to identify potential responders to cardiac resynchronization therapy in this patient population? Answers to these and more questions are still lacking.
Collapse
|
14
|
|
15
|
Yamauchi Y, Aonuma K, Hachiya H, Isobe M. Permanent His-Bundle Pacing After Atrioventricular Node Ablation in a Patient With Chronic Atrial Fibrillation and Mitral Regurgitation. Circ J 2005; 69:510-4. [PMID: 15791053 DOI: 10.1253/circj.69.510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hemodynamic deterioration because of worsening of mitral regurgitation can occur in a small number of patients undergoing atrioventricular node (AVN) ablation and pacing therapy. Patients with moderate mitral regurgitation before ablation seem prone to this complication. Successful permanent His-bundle pacing after AVN ablation was performed in a patient with chronic atrial fibrillation and moderate mitral regurgitation. Pulmonary capillary wedge pressure V-wave amplitude was markedly diminished and the mitral regurgitation area, calculated from the echocardiogram, was decreased by His-bundle pacing compared with that during right ventricular outflow tract or apical pacing.
Collapse
Affiliation(s)
- Yasuteru Yamauchi
- Cardiology Department, Musashino Red Cross Hospital, Tokyo 180-8610, Japan.
| | | | | | | |
Collapse
|
16
|
Giudici MC, Barold SS, Paul DL, Schrumpf PE, Van Why KJ, Orias DW. Right Ventricular Outflow Tract Placement of Defibrillation Leads:. Five Year Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:443-6. [PMID: 15078395 DOI: 10.1111/j.1540-8159.2004.00461.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over a 5-year period, 112 patients (89 male/23 female, mean age 65 years) underwent right ventricular outflow tract (RVOT) placement of permanent active-fixation transvenous pacing/defibrillating leads. At implantation, the pacing threshold was 0.6 +/- 0.3 V at 0.5 ms pulse duration and R wave amplitude was 10.9 +/- 4.9 mV. The defibrillation threshold (DFT) of right-sided implants was 17.7 +/- 3.4 J while that of left-sided implants was 16.1 +/- 3.3 J. Patients were followed at 1 and 3 month postimplant and at six-month intervals thereafter. At mean follow-up of 22.5 +/- 17.5 months (range 1-47 months) there were no lead dislodgments, unsuccessful shock therapies, or failure to sense or pace for bradycardia or tachycardia. Death was not sudden in the 17 patients who died. We conclude that RVOT pacing-defibrillation lead implantation is safe, efficacious, and potentially attractive because preliminary evidence suggests that it may not be associated with the adverse hemodynamic effects of pacing at the right ventricular apex.
Collapse
Affiliation(s)
- Michael C Giudici
- Division of Cardiology, Genesis Heart Institute, Davenport, Iowa 52803, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Weinstock J, Wang PJ, Homoud MK, Link MS, Estes NAM. Clinical results with catheter ablation: AV junction, atrial fibrillation and ventricular tachycardia. J Interv Card Electrophysiol 2003; 9:275-88. [PMID: 14574041 DOI: 10.1023/a:1026205028816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With the limitations of pharmacologic and device therapies for atrial fibrillation and ventricular tachycardia, catheter ablation is assuming a larger role in the management of patients with these common arrhythmias. Multiple case series and clinical trials have helped to define the evolving role of these techniques for ablation of the atrioventricular node, atrial fibrillation, and ischemic ventricular tachycardia. Based on very low complication rates, excellent efficacy and proven outcomes with radiofrequency ablation of the atrioventricular node, this approach with permanent pacing should play a larger role in the treatment of symptomatic patients with permanent atrial fibrillation. While linear ablation of atrial fibrillation has limited clinical utility for the treatment of this common arrhythmia, the results of multiple case series of focal atrial fibrillation ablation indicate the potential for an expanding role of this curative technique. Catheter ablation techniques for ventricular tachycardia in the setting of coronary artery disease have a role as supplemental therapy to the implantable cardioverter defibrillator in patients with recurrent pharmacologically refractory ventricular arrhythmias requiring frequent device interventions.
Collapse
Affiliation(s)
- Jonathan Weinstock
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA
| | | | | | | | | |
Collapse
|
18
|
Anguera I. [Ventricular pacing after atrioventricular node ablation]. Rev Esp Cardiol 2002; 55:689; author reply 689-90. [PMID: 12113731 DOI: 10.1016/s0300-8932(02)76680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Yeung-Lai-Wah JA, Qi A, Uzun O, Humphries K, Kerr CR. Long-term survival following radiofrequency catheter ablation of atrioventricular junction for atrial fibrillation: clinical and ablation determinants of mortality. J Interv Card Electrophysiol 2002; 6:17-23. [PMID: 11839879 DOI: 10.1023/a:1014168021615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND For patients with drug-refractory atrial fibrillation, radiofrequency catheter ablation of the atrioventricular junction and pacemaker implantation is a nonpharmacologic option routinely used nowadays. Few data are available on the long-term survival following the procedure or on evaluation of the risk factors for death in a large study cohort. METHODS The patient population included 359 subjects undergoing atrioventricular junction ablation and pacemaker insertion. Fourteen clinical and 9 ablation variables were collected at baseline. During a mean following-up of 40.8 +/- 25.6 months, 46 patients died. Survival probability was estimated by the Kaplan-Meier methods. Multivariate Cox proportional hazards regression analysis was applied to define predictors of death. RESULTS Mean age was 64.6 +/- 10.6 years with 203 male (57.7%). Actuarial survival probability for the total patients was 0.953 and 0.827 at 1 and 5 year. Four clinical variables, but no ablation variables, were found to be independent predictors of death: age > or =65 year (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.00-3.69), the presence of heart failure (HR, 3.83; 95% CI, 1.87-7.86), coexisting diabetes (HR, 2.91; 95% CI, 1.47-5.77), and the value of fractional shortening < or =20% (HR, 5.79, 95% CI, 3.00-11.18). There were 20 deaths in 28 patients with > or =3 risk factors and 4 deaths in 115 patients with no risk factor. CONCLUSION The risk of death in patients undergoing ablation and pacing can be identified by readily available clinical variables. Patients with multiple risk factors are associated with an increasing mortality.
Collapse
Affiliation(s)
- John A Yeung-Lai-Wah
- Division of Cardiology, Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada, V6ZA 1Y6.
| | | | | | | | | |
Collapse
|
20
|
Melton IC, Wood MA, Ellenbogen KA. Radiofrequency atrioventricular junction ablation for atrial fibrillation: how can we make it better? Am Heart J 1999; 138:1016-8. [PMID: 10577429 DOI: 10.1016/s0002-8703(99)70064-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|