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. 2003 Sep;89(9):1035-8.
doi: 10.1136/heart.89.9.1035.

Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation

A Queiroga  1 , H J Marshall, M Clune, M D Gammage
Affiliations

Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation

A Queiroga et al. Heart. 2003 Sep.

Abstract

Objective: To assess long term mortality and identify factors associated with the development of permanent atrial fibrillation after atrioventricular (AV) node ablation for drug refractory paroxysmal atrial fibrillation.

Design: Retrospective cohort study.

Setting: UK tertiary centre teaching hospital.

Patients: Patients admitted to the University Hospital Birmingham between January 1995 and December 2000.

Interventions: AV node ablation and dual chamber mode switching pacing.

Main outcome measures: Long term mortality and predictors of permanent atrial fibrillation, assessed through Kaplan-Meier curves and logistic regression.

Results: 114 patients (1995-2000) were included: age (mean (SD)), 65 (9) years; 55 (48%) male; left atrial diameter 4 (1) cm; left ventricular end diastolic diameter 5 (1) cm; ejection fraction 54 (17)%. Indications for AV node ablation were paroxysmal atrial fibrillation in 95 (83%) and paroxysmal atrial fibrillation/flutter in 19 (17%). The survival curve showed a low overall mortality after 72 months (10.5%). Fifty two per cent of patients progressed to permanent atrial fibrillation within 72 months. There was no difference in progression to permanency between paroxysmal atrial fibrillation and paroxysmal atrial fibrillation/flutter (log rank 0.06, p = 0.8). Logistic regression did not show any association between the variables collected and the development of permanent atrial fibrillation, although age over 80 years showed a trend (p = 0.07).

Conclusions: Ablate and pace is associated with a low overall mortality. No predictors of permanent atrial fibrillation were identified, but 48% of patients were still in sinus rhythm at 72 months. These results support the use of dual chamber pacing for paroxysmal atrial fibrillation patients after ablate and pace.

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Figures

Figure 1
Figure 1
(A) Overall mortality after atrioventricular (AV) node ablation for drug refractory paroxysmal atrial fibrillation (AF): 10.5% of patients had died at 72 months after the implant. (B) Survival according to the indication for AV node ablation. There was no difference between paroxysmal AF (PAF) and paroxysmal AF/flutter (PAF/flutter): log rank = 0.63; p = 0.83.
Figure 2
Figure 2
(A) Proportion of patients without permanent atrial fibrillation (AF) after atrioventricular node ablation: 52% of patients progressed to permanent AF at 72 months. (B) There was no difference between paroxysmal AF (PAF) and paroxysmal AF/flutter (PAF/flutter): log rank = 0.06; p = 0.81.
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