Atrioventricular nodal ablation and implantation of mode switching dual chamber pacemakers: effective treatment for drug refractory paroxysmal atrial fibrillation

• Published in: Heart (British Cardiac Society) Vol. 79; no. 6; pp. 543 - 547
• Main Authors: Marshall, H J, Harris, Z I, Griffith, M J, Gammage, M D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-06-1998; BMJ; BMJ Publishing Group LTD
• Subjects: Ablation; Adult; Aged; Atrial Fibrillation - surgery; Atrial Fibrillation - therapy; atrioventricular node ablation; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Cardiovascular disease; Catheter Ablation - methods; Catheters; Combined Modality Therapy; drug refractoriness; Drugs; dual chamber pacemaker; Female; Follow-Up Studies; Heart; Humans; Ischemia; Male; Medical sciences; Middle Aged; Pacemakers; paroxysmal atrial fibrillation; Postoperative Period; Quality of Life; Questionnaires; Sinuses; Statistics, Nonparametric; Treatment Outcome; United States > US; Minnesota; Human; Arrhythmia; Atrial fibrillation; Electrical stimulus; Right ventricle; Instrumentation therapy; Cardiovascular disease; Antiarrhythmic agent; Radiofrequency; Ablation; Excitability disorder; Instrumental stimulation; Chemotherapy; Treatment; Pacemaker; Heart disease; Atrioventricular node; Technique; Right atrium; Negative therapeutic reaction
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.79.6.543

Objective To assess the effect of atrioventricular node ablation and implantation of a dual chamber, mode switching pacemaker on quality of life, exercise capacity, and left ventricular systolic function in patients with drug refractory paroxysmal atrial fibrillation. Patients 18 consecutive patients with drug refractory paroxysmal atrial fibrillation. Methods Quality of life was assessed before and after the procedure using the psychological general wellbeing index (PGWB), the McMaster health index (MHI), and a visual analogue scale for cardiac symptoms. Nine of the patients also underwent symptom limited exercise tests and echocardiography to assess left ventricular systolic function. Results The procedure allowed a reduction in antiarrhythmic drug treatment (p < 0.01). PGWB and symptom scores improved (p < 0.01) but the MHI score did not change. Left ventricular systolic function and exercise capacity were unchanged. Conclusions Atrioventricular node ablation and implantation of a DDDR/MS pacemaker is effective treatment for refractory paroxysmal atrial fibrillation, producing improved quality of life while allowing a reduction in drug burden. The popularity of the treatment is justified, but further studies are needed to determine optimum timing of intervention.