Is There a Role for Bi-Atrial Pacing Resynchronisation Therapy in the Management of Drug-Refractory Atrial Fibrillation in Patients Unsuitable for Left Atrial Ablation?

• Published in: Circulation Journal Vol. 75; no. 1; pp. 67 - 72
• Main Authors: Sankaranarayanan, Rajiv, James, Michael Anthony, Gonna, Hanney, Burtchaell, Stephanie, Holloway, Russell, Ewings, Paul
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2011
• Subjects: Ablation; Aged; Aged, 80 and over; Anti-Arrhythmia Agents - therapeutic use; Atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Fibrillation - therapy; Cardiac Resynchronization Therapy - adverse effects; Catheter Ablation - adverse effects; Drug Resistance; England; Female; Hospitalization; Humans; Male; Middle Aged; Pacing; Patient Selection; Recurrence; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome; England
• DOI: 10.1253/circj.CJ-10-0571
• EISSN: 1347-4820
• ISSN: 1346-9843

Background: This retrospective cohort study evaluated whether long term outcome of atrial resynchronisation therapy using bi-atrial pacing (BiaP) to treat atrial fibrillation (AF) was effective in patients deemed unfit for left atrial (LA) ablation procedures. Methods and Results: The patient population comprised 2 groups: those deemed suitable for left LA ablation (n=14) and those who were not (n=17). Both groups underwent BiaP and outcomes were evaluated by comparing symptoms, AF duration, admissions and antiarrhythmic drugs (AAD) for an equal period of time pre and post implantation. Median follow-up was 24 months (range 8-66 months) for the unsuitable group and 31 months (range 7-84 months) for the suitable group. Efficacy in reduction of both AF and symptoms was similar (P=0.44) in both groups (unsuitable group: 13/17; suitable group: 8/14). There was significant improvement in median AF episodes/week pre and post BiaP in both groups (unsuitable group AF reduction: 5 days/week, P=0.001; suitable group AF reduction: 4.9 days/week, P=0.03); the improvement was similar in both groups (P=0.33). There was a significant reduction in the median number of admissions for AF in both groups (unsuitable group: P=0.003; suitable group: P=0.01) and this reduction was also similar (P=0.70). The median number of AAD was also reduced to a similar degree (P=0.83) in both groups (suitable group: P=0.004; unsuitable group: P=0.001). Conclusions: Atrial resynchronisation therapy is effective in the long term management of drug-resistant AF in patients unsuitable for LA ablation, leading to significant reductions in symptoms, AF duration, admissions and AAD. (Circ J 2011; 75: 67-72)