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Willy K, Reinke F, Ellermann C, Leitz P, Wasmer K, Köbe J, Lange PS, Kochhäuser S, Dechering D, Eckardt L, Frommeyer G. Long-term experience of atrioventricular node ablation in patients with refractory atrial arrhythmias. Heart Vessels 2019; 35:699-704. [PMID: 31705185 DOI: 10.1007/s00380-019-01536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation and other atrial tachyarrhythmias are increasing with age and concomitant morbidity. First options in symptomatic patients are drug treatment and catheter ablation. Nevertheless, a considerable number of patients suffer from refractory atrial tachyarrhythmias despite treatment. Atrioventricular node ablation (AVNA) may be helpful in many of these patients. Therefore, we investigated AVNA patients with a long-term follow-up. We enrolled 82 patients with a follow-up longer than 1 year receiving AVNA for drug- and ablation-resistant atrial tachyarrhythmias (AA) in a retrospective manner. Mean follow-up duration was 48 ± 24 months. 50% of the patients initially received AVNA to optimize biventricular pacing in cardiac resynchronization therapy, the other 50% because of refractory symptomatic tachyarrhythmias. Persistent AV block was achieved in every patient. Symptom relief and patient satisfaction were high during follow-up. Due to system upgrades there were 63% of patients with a biventricular system during follow-up. In these patients, left-ventricular ejection fraction (LV-EF) increased by 7% (42-49%) after ablation. AVNA is effective in increasing biventricular pacing as well as for symptom relief in patients with refractory atrial tachyarrhythmias. AVNA should be considered as a valuable option in patients with refractory atrial tachyarrhythmias lacking other treatment options.
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Affiliation(s)
- Kevin Willy
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Patrick Leitz
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Philipp S Lange
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Dirk Dechering
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
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Raymond-Paquin A, Andrade J, Macle L. Catheter ablation: an ongoing revolution. J Thorac Dis 2019; 11:S212-S215. [PMID: 30997179 DOI: 10.21037/jtd.2019.02.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandre Raymond-Paquin
- Electrophysiology Service, Montreal Heart Institute, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
| | - Jason Andrade
- Electrophysiology Service, Montreal Heart Institute, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada.,Heart Rhythm Services, Department of Medicine, The University of British Columbia, British Columbia, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Canada
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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.
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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
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