Initial and long-term evaluation of escape rhythm after radiofrequency ablation of the AV junction in 50 patients.
Between 1986 and 1994, 50 patients (mean age 63 +/- 13 years), 25 of whom had organic heart disease and presenting with atrial arrhythmias refractory to 5.6 +/- 1.6 antiarrhythmic drugs, underwent radiofrequency ablation (5 +/- 3 pulses by procedure; duration of pulses 50.5 +/- 32 s) of the proximal AV junction to create complete and permanent AV block. The escape rhythm was studied immediately after the procedure and during long-term follow-up. Immediately after the procedure, an escape rhythm was observed in 80% of the patients (junctional in 92%). Over a mean follow-up of 36 +/- 16 months in 47 patients (2 patients died before assessment of escape rhythm and 1 was lost to follow-up), an escape rhythm was present in 39 patients (83%) and absent in the remaining 8 (17%). The only significant difference between the two groups was the initial presence of an escape rhythm (P = 0.008). However, three patients with an initial escape rhythm had none during long-term follow-up. The initial presence of an escape rhythm as a predictive factor of its presence during follow-up had a sensitivity of 87%, specificity of 63%, positive predictive value of 92%, and negative predictive value of 50%. Thus, the absence of an escape rhythm during long-term follow-up causing pacemaker dependency was noted in 1 of 6 patients. This represents a limitation to this palliative treatment, which should be reserved for patients suffering from supraventricular tachycardias refractory to other treatments.
Piot
O
O
Department of Cardiology, Antoine-Béclère Hospital, Clamart, France.
Sebag
C
C
Lavergne
T
T
Ollitrault
J
J
Johnson
N
N
Dinanian
S
S
Le Heuzey
J Y
JY
Guize
L
L
Motté
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery; D001282:Atrial Flutter / Q000601:surgery; D001283:Atrioventricular Node / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006327:Heart Block / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012680:Sensitivity and Specificity; D013617:Tachycardia, Supraventricular / Q000601:surgery
D000889:Anti-Arrhythmia Agents