title: Symptomatic improvement after AV nodal ablation and pacemaker implantation for refractory atrial fibrillation and atrial flutter.
abstract: Symptomatic Improvement was evaluated in 64 patients with drug-refractory atrial fibrillation or atrial flutter who underwent atrioventricular (AV) nodal ablation and permanent pacemaker implantation. The arrhythmias were chronic in 40 patients and paroxysmal in 24 patients. All were refractory to multiple drugs (3.7 +/- 1.5) and had severe symptoms: palpitations (58 patients), dyspnea (n=58), dizziness (n=38), asthenia (n=37), and chest pain (n=20). All underwent AV nodal ablation and single- (n=39) or dual-chamber (n=25) pacemaker implantation. During follow-up of 20.4 +/- 17.8 months, palpitations improved in 100% of 58 patients who had palpitations before the ablation, dyspnea improved in 75% of 58 patients, chest pain in 95% of 20 patients, asthenia in 75% of 37 patients, and dizziness in 93% of 38 patients. Moderate to significant improvement in these symptoms was reported in 83% of patients and mild improvement in 5%. Before ablation, 77% of patients were in New York Heart Association functional class III or IV. After ablation, 19% of patients were in the same functional classes (P < 0.05). Thus, AV nodal ablation and pacemaker implantation in patients with drug-refractory atrial fibrillation or flutter was associated with significant improvement in presenting symptoms and functional capacity. A randomized, controlled study is needed to compare this form of therapy with other therapeutic modalities.
authors.affiliation: Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Kim
authors.forename: V
authors.initials: V
authors.lastname: Sompalli
authors.forename: A
authors.initials: A
authors.lastname: Rameneni
authors.forename: M K
authors.initials: MK
authors.lastname: Gadde
authors.forename: M
authors.initials: M
authors.lastname: Pamidi
authors.forename: R
authors.initials: R
authors.lastname: Pathapati
authors.forename: K J
authors.initials: KJ
authors.lastname: Ferrick
authors.forename: J
authors.initials: J
authors.lastname: Gross
authors.forename: U
authors.initials: U
authors.lastname: Ben-Zur
authors.forename: S
authors.initials: S
authors.lastname: Furman
authors.forename: J D
authors.initials: JD
authors.lastname: Fisher
mesh_terms: D000368:Aged; D001247:Asthenia / Q000209:etiology; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001282:Atrial Flutter / Q000150:complications / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D002637:Chest Pain / Q000209:etiology; D015986:Confounding Factors, Epidemiologic; D004244:Dizziness / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome