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Europace Advance Access originally published online on October 24, 2007
Europace 2007 9(12):1119-1123; doi:10.1093/europace/eum226
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

PACING FOR ATRIAL FIBRILLATION

Evaluation of pacemaker dependence in patients on ablate and pace therapy for atrial fibrillation

Eraldo Occhetta1,*, Miriam Bortnik1, Gabriele Dell’Era1, Fabio Zardo2, Ermanno Dametto2, Biagio Sassone3, Luca Gabrieli3 and Paolo Marino1

1 Cardiology Division, Azienda Ospedaliera Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy; 2 Cardiology Division, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy; 3 Cardiology Division, Ospedale di Bentivoglio, Bologna, Italy

Aims: In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction.

Methods and results: One-hundred and sixty-three patients (71 men; mean age 71 ± 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life.

Conclusion: This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.

Key Words: Pacemaker dependence, Atrial fibrillation, Ablate and pace therapy

* Corresponding author. Tel: +39 0321 3733413; fax: +39 0321 3733142. E-mail address: occhetta{at}r-j.it, eraldo.occhetta{at}maggioreosp.novara.it

Manuscript submitted 6 June 2007. Revision received 18 September 2007.
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