Long-term survival following radiofrequency catheter ablation of atrioventricular junction for atrial fibrillation: clinical and ablation determinants of mortality.
BACKGROUND
For patients with drug-refractory atrial fibrillation, radiofrequency catheter ablation of the atrioventricular junction and pacemaker implantation is a nonpharmacologic option routinely used nowadays. Few data are available on the long-term survival following the procedure or on evaluation of the risk factors for death in a large study cohort.


METHODS
The patient population included 359 subjects undergoing atrioventricular junction ablation and pacemaker insertion. Fourteen clinical and 9 ablation variables were collected at baseline. During a mean following-up of 40.8 +/- 25.6 months, 46 patients died. Survival probability was estimated by the Kaplan-Meier methods. Multivariate Cox proportional hazards regression analysis was applied to define predictors of death.


RESULTS
Mean age was 64.6 +/- 10.6 years with 203 male (57.7%). Actuarial survival probability for the total patients was 0.953 and 0.827 at 1 and 5 year. Four clinical variables, but no ablation variables, were found to be independent predictors of death: age > or =65 year (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.00-3.69), the presence of heart failure (HR, 3.83; 95% CI, 1.87-7.86), coexisting diabetes (HR, 2.91; 95% CI, 1.47-5.77), and the value of fractional shortening < or =20% (HR, 5.79, 95% CI, 3.00-11.18). There were 20 deaths in 28 patients with > or =3 risk factors and 4 deaths in 115 patients with no risk factor.


CONCLUSIONS
The risk of death in patients undergoing ablation and pacing can be identified by readily available clinical variables. Patients with multiple risk factors are associated with an increasing mortality.
Yeung-Lai-Wah
John A
JA
Division of Cardiology, Department of Medicine, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada, V6ZA 1Y6. jayeung@axion.net
Qi
Anzhen
A
Uzun
Orhan
O
Humphries
Karin
K
Kerr
Charles R
CR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome