Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation - Effects of pacing mode and mode-switch algorithm

Article

关键词: QUALITY-OF-LIFE;    RADIOFREQUENCY CATHETER ABLATION;    TERM FOLLOW-UP;    ATRIOVENTRICULAR JUNCTION;    LONG-TERM;    INITIAL EXPERIENCE;    PACEMAKER;    TACHYARRHYTHMIAS;    ARRHYTHMIAS;    CROSSOVER;   

DOI  :  10.1161/01.CIR.99.12.1587

来源: SCIE

【 摘 要 】

Background-Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated. Methods and Results-Symptomatic patients who had tried greater than or equal to 2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring, Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P<0.01), palpitations (-58%, P=0.0001), and dyspnea (-37%, P<0.05). Changes in score from baseline were better with ablation and DDDR/MS pacing for overall symptoms (-48% versus -4%, P<0.005), palpitation (-62% versus -5%, P<0.001), dyspnea (-44% versus -3%, P<0.005), and PGWB (+12% versus +0.5%, P<0.05). DDDR/MS was better than VVIR pacing for overall symptoms (-21%, P<0.05), dyspnea (-30%, P<0.005), and MHI (+5%, P<0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19, P<0.01). Conclusions-Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.

【 授权许可】

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