© 1999 by European Society of Cardiology
Chronic atrial fibrillation in patients with paroxysmal atrial fibrillation, atrioventricular node ablation and pacemakers
Determinants and treatment
Regional Cardiothoracic Centre, Freeman Hospital Newcastle upon Tyne, U.K.
Aims
This study examined the factors associated with the development of chronic (or permanent) atrial fibrillation (AF) in patients who had undergone atrioventricular (AV) node ablation with permanent pacing because of paroxysmal AF.
Methods
A retrospective review of case notes of all 65 consecutive patients identified as having had paroxysmal atrial arrhythmias, AV node ablation and permanent pacemaker implantation was performed. Atrial rhythm was established from all pacing records and from the surface ECG. Treatment with anti-arrhythmic drugs and with warfarin was recorded. A multivariate analysis was undertaken, using atrial rhythm on final ECG and chronic AF as outcome measures.
Results
During a mean follow-up of 30 months, 42% of patients with paroxysmal AF had developed chronic AF. Multivariate analysis showed that increasing age, history of electrical cardioversion and VVI pacing all contributed to the development of chronic AF. 25/62 patients were taking warfarin, and four had had strokes (2·5%/year).
Conclusions
The majority of patients with paroxysmal atrial arrhythmias treated with AV node ablation and pacing develop chronic AF eventually. Stroke remains a risk, particularly in those who develop chronic AF.
Key Words: Atrial fibrillation, paroxysmal, atrioventricular node ablation, permanent pacemaker, DDD, VVI, stroke.
Correspondence: Dr J. M. McComb, Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, U.K.
[1] Sutton R and Kenny RA. The natural history of sick sinus syndrome. PACE 1986; 9: 1110–1114.
[2] Hesselson AB, Parsonnet V, Bernstein AD, Bonavita GJ. Deleterious effects of long term single chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual chamber pacing. J Am Coll Cardiol 1992; 19: 1542–1549.[Abstract]
[3] Sgarbossa EB, Pinski SL, Maloney JD, et al. Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities. Circulation 1993; 88: 1045–1053.
[4] Lamas GA. Pacemaker mode selection and survival: a plea to apply the principles of evidence based medicine to cardiac pacing practice. Heart 1997; 78: 224–225.
[5] Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Bloch Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sick sinus syndrome. Lancet 1994; 344: 1523–1528.[CrossRef][Web of Science][Medline]
[6] Andersen HR, Nielsen JC, Bloch Thomsen PE, et al. Long-term follow-up of patients from a randomised trial of atrial versus ventricular pacing for sick-sinus syndrome. Lancet 1997; 350: 1210–1216.[CrossRef][Web of Science][Medline]
[7] Gross JN, Moser S, Benedek ZM, Benedek ZM, Andrews C, Furman S. DDD pacing mode survival in patients with a dual-chamber pacemaker. J Am Coll Cardiol 1992; 19: 1536–1541.[Abstract]
[8] Aboaf AP and Wolf PS. Paroxysmal atrial fibrillation A common but neglected entity. Arch Int Med 1996; 156: 362–367.
[9] Mitchell MA, Ackerman SJ, Nath S, Haines DE, DiMarco JP. Atrial rhythm after atrioventricular junctional ablation. Am J Cardiol 1996; 78: 1251–1254.[CrossRef][Web of Science][Medline]
[10] Kannel W, Abbott R, Savage D, McNamara P. Epidemiological features of atrial fibrillation. The Framingham Study. N Engl J Med 1982; 306: 1018–1022.[Abstract]
[11] Cresswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993; 56: 539–549.[Abstract]
[12] Brignole M, Gianfranchi L, Menozzi C, et al. Assessment of atrioventricular junction ablation and DDDR mode switching pacemaker versus pharmacological treatment in patients with severely symptomatic paroxysmal atrial fibrillation A randomized controlled study. Circulation 1997; 96: 2617–2624.
[13] Feuer JM, Shandling AH, Messenger JC. Influence of cardiac pacing mode on the long-term development of atrial fibrillation. Am J Cardiol 1989; 64: 1376–1379.[CrossRef][Web of Science][Medline]
[14] Brandt J, Anderson H, Få hraeus T, Schüller H. Natural history of sinus node disease treated with atrial pacing in 213 patients: implications for selection of stimulation mode. J Am Coll Cardiol 1992; 20: 633–639.[Abstract]
[15] Sopher SM and Camm AJ. Atrial fibrillation: maintenance of sinus rhythm versus rate control. Am J Cardiol 1996; 77: 24A–37A.[CrossRef][Medline]
[16] Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation Study: Final results. Circulation 1991; 84: 527–539.
[17] Flaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG. on behalf of the Stroke Prevention in Atrial Fibrillation Investigators. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. Circulation 1992; 20: 527–532.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. R. Betts Atrioventricular junction ablation and pacemaker implant for atrial fibrillation: still a valid treatment in appropriately selected patients Europace, April 1, 2008; 10(4): 425 - 432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Brignole, M. Gammage, L. Jordaens, R. Sutton, and on behalf of the Barcelona Discussion Group Report of a study group on ablate and pace therapy for paroxysmal atrial fibrillation Europace, January 1, 1999; 1(1): 8 - 13. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||