Significant effects of atrioventricular node ablation and pacemaker implantation on left ventricular function and long-term survival in patients with atrial fibrillation and left ventricular dysfunction
Section snippets
Study group
The study group consisted of 56 patients with drug-refractory paroxysmal, permanent, or chronic AF and LV dysfunction (EF ≤40%) who underwent atrioventricular node ablation and pacemaker implantation between July 1990 and December 1998. This group of patients was drawn from a total of 350 patients who underwent the procedure during this period.
Control groups
A group of control patients consisted of 56 age- and gender-matched patients with AF and LVEF >40% who underwent atrioventricular node ablation and
Demographic characteristics
The baseline characteristics of the study and control patients are compared in Table 1. In addition to data presented in Table 1, right-sided ablation was performed in all study patients except 1, in whom a retrograde aortic approach was used. A rate-responsive ventricular pacemaker was implanted in 61% of patients, and a dual-chamber rate-responsive pacemaker was implanted in 39%. Before ablation, 3 patients had cardiac arrest; after ablation, cardiac arrest was documented in only 1 patient.
Discussion
Our study demonstrated that: (1) observed survival was significantly worse in study patients than in age- and gender-matched control patients with an LVEF >40%; (2) observed survival was significantly worse in study patients than in age- and gender-matched normal control subjects drawn from the Minnesota population; (3) near normalization of LVEF (≥45%) occurred in 29% of study patients, suggesting that AF-induced reduction in LVEF is reversible in a marked subset of patients; (4) observed
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