title: Long-term follow-up after atrioventricular nodal ablation and pacing: low incidence of sudden cardiac death.
abstract: Sudden cardiac death (SCD) has been reported in patients with drug refractory AF who underwent AV nodal ablation and pacing. However, whether SCD in these patients is related to the underlying heart disease or to the ablating and pacing procedure remains uncertain. Between May 1987 and January 1997, AV nodal ablation was performed in 585 patients (mean age 66 +/- 11 years) with drug-resistant, paroxysmal (n = 308) or chronic (n = 277) AF in 12 Italian centers. Lone AF was present in 133 patients. After AV junction ablation, patients underwent VVIR (454 patients) or DDDR (131 patients) pacemaker implantation. At a follow-up of 33.6 +/- 24.2 months, 80 (13.7%) deaths were recorded: 40 noncardiac, 23 nonsudden, and 17 sudden cardiac death (3%, 1.04% per year). Among five variables, including age. NYHA functional class, presence of heart disease, paroxysmal or chronic AF, previous embolic events, and LVEF, the presence of heart disease (P = 0.007) and a LVEF < 0.45, (P = 0.003) were associated with a higher risk of SCD. Analysis of SCD-free survival by log-rank test showed a higher incidence of SCD in patients with LVEF < 0.45 (P = 0.0001) and with coronary artery disease (P = 0.005). In this large cohort, a low incidence of long-term SCD after AV nodal ablation and pacing for drug-refractory AF was observed. The presence of underlying heart disease and the extent of baseline LV dysfunction were associated with an increased likelihood of SCD.
authors.affiliation: Cardiac Electrophysiology and Pacing Unit, Istituto Clinico Humanitas, Via Manzoni 56 Rozzano, 20089 Milano, Italy. maurizio.gasparini@humanitas.it
authors.forename: M
authors.initials: M
authors.lastname: Gasparini
authors.forename: M
authors.initials: M
authors.lastname: Mantica
authors.forename: M
authors.initials: M
authors.lastname: Brignole
authors.forename: F
authors.initials: F
authors.lastname: Coltorti
authors.forename: P
authors.initials: P
authors.lastname: Galimberti
authors.forename: L
authors.initials: L
authors.lastname: Gianfranchi
authors.forename: C
authors.initials: C
authors.lastname: Menozzi
authors.forename: G
authors.initials: G
authors.lastname: Magenta
authors.forename: P
authors.initials: P
authors.lastname: Delise
authors.forename: A
authors.initials: A
authors.lastname: Proclemer
authors.forename: S
authors.initials: S
authors.lastname: Tognarini
authors.forename: R
authors.initials: R
authors.lastname: Ometto
authors.forename: F
authors.initials: F
authors.lastname: Acquati
authors.forename: R
authors.initials: R
authors.lastname: Mantovan
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D015996:Survival Rate; D013995:Time; D016896:Treatment Outcome