© 2002 by European Society of Cardiology
PACING
Deterioration of left ventricular function following atrio-ventricular node ablation and right ventricular apical pacing in patients with permanent atrial fibrillation
Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam Rotterdam, The Netherlands
Manuscript submitted 21 January 2001. Accepted after revision 20 October 2001.
Correspondence: Tamas Szili-Torok, MD, Department of Clinical Electrophysiology, Thoraxcentre, Rotterdam, Dr Molewaterplein 40, 3015 GM, Rotterdam, The Netherlands. E-mail: szili{at}card.azr.nl
Key Words: Atrial fibrillation, ablation, atrioventricular node, cardiac function
Aims
Transcatheter radiofrequency ablation of the atrio-ventricular (AV) node followed by ventricular pacing has been shown to improve symptoms and quality of life of patients with atrial fibrillation (AF). It is assumed that function improves, but this has been less well demonstrated. The aim of this study was to assess the long-term effect of AV node ablation and ventricular pacing on left ventricular ejection fraction (LVEF) in patients with permanent AF.
Methods and Results
All 12 patients studied had permanent AF for at least 12 months (mean age 70 years, range 41 to 78). LVEF was determined 6 days and 3 months after AV node ablation by radionuclide ventriculography, at a paced rate of 80 beats . min–1. Cardiac dimensions were measured by means of transthoracic echocardiography. No major changes in pharmacological therapy were made during 3 months follow-up period. LVEF showed a significant deterioration after 3 months follow-up period for the group (47·5±14·4%; 6 days after ablation vs 43·2±13·7%; 3 months after ablation, P< 0·05). There were no significant differences in left ventricular cavity dimensions directly after AV node ablation and 3 months later (LVEDD 51·2±10·7 mm vs 52·6±8·6 mm, P=NS; LVESD: 36·1± 14·2 mm vs 36·6±9·7 mm, P=NS). Left atrial size did not show reduction 3 months after AV node ablation (50·8±13·6 mm vs 51·0±14·1 mm, P=NS).
Conclusion
The restoration of a regular ventricular rhythm following AV node ablation for patients in permanent AF does not result in improvement in left ventricular function.
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