Long-term follow-up after catheter-ablation of atrioventricular junction and pacemaker implantation in patients with uncontrolled atrial fibrillation and heart failure

Srpski Arhiv za Celokupno Lekarstvo

关键词: atrial fibrillation;    heart failure;    catheter-ablation;    AV junction ablation;    tachycardiomyopathy;   

DOI  :  10.2298/SARH1110591M

来源: DOAJ

【 摘 要 】

Introduction. Atrioventricular (AV) junction ablation coupled with pacemakerimplantation is an effective therapeutic option for rate control in atrialfibrillation (AF) and heart failure (HF). However, there is controversyregarding the long-term outcome of the procedure, since right ventricularstimulation can lead to left ventricular remodelling and HF. Objective. Theaim of the study was to determine a 5-year outcome of the procedure onsurvival, HF control and myocardial function in patients with HF anduncontrolled AF. Methods. All patients with AF and HF who underwentAV-junction ablation with pacemaker implantation in our institution werefollowed after the procedure. HF diagnosis was established if ≥2 of thefollowing criteria were present: 1) ejection fraction (EF) ≤45%; 2) previousepisode of congestive HF (CHF); 3) NYHA-class ≥2; and 4) use of drug-therapyfor HF. Results. Study included 32 patients (25 males; 53.4±9.6 years). Themean heart rate was 121±25 bpm before and 75±10 bpm after ablation (p=0.001).Over the follow-up of 5.0±4.0 years nine patients (28.1%) died (five diedsuddenly, three of terminal CHF and one of stroke). After the procedure, CHFoccurrence was reduced (p=0.001), as well as the annual number ofhospitalizations (p=0.001) and the number of drugs for CHF (p=0.028). Inaddition, NYHA-class and EF were improved, from 3.3±0.7 to 1.6±0.8 (p<0.001)and from 39±11% to 51±10% (p<0.001), respectively. Conclusion. In HF patientswith uncontrolled AF, 5-year mortality after AV-junction ablation andpacemaker implantation was 28%. In the majority of these patients good rateof AF and HF control were achieved, as well as the improvement of functionalstatus and myocardial contractility.

【 授权许可】

Unknown