title: AV nodal ablation and pacemaker implantation improves hemodynamic function in atrial fibrillation.
abstract: In drug refractory and highly symptomatic atrial fibrillation (AF) patients, hemodynamic effects of AV node ablation and pacing therapy (APT) were evaluated. Thirty-eight patients with drug refractory and symptomatic AF, underwent APT in eight centers in Japan. The outcome of this therapy was assessed in terms of quality-of-life, cardiac performance measured by echocardiogram, and plasma ANP and BNP levels before and after APT. Quality-of-life assessed by self-administered semi-quantitative questionnaires: WHO QOL 26 (3.0 +/- 0.5 vs 3.4 +/- 0.6, P < 0.01) and the Symptom Checklist: Frequency Scale (1.6 +/- 0.6 vs 0.7 +/- 0.7, P < 0.01) and Severity Scale (1.3 +/- 0.4 vs 0.6 +/- 0.6, P < 0.01), improved significantly 6 months after APT. Ejection fraction (EF) by echocardiogram improved 1 week after APT (59.0% +/- 13.3% vs 63.3% +/- 11.6%, P = 0.02). Plasma ANP levels in the group of ANP > 40 pg/mL at enrollment significantly decreased 1 month later (P = 0.03), and plasma BNP levels in the group of BNP > 20 pg/mL at enrollment significantly decreased 1 month later (P < 0.01). In conclusion, APT has beneficial hemodynamic effects, and plasma BNP levels can predict the most optimal candidates for ablation and pacing therapy.
authors.affiliation: Cardiovascular Division, Tsuchiura Kyoudo Hospital, Tokyo, Japan. yoshit@tf6.so-net.ne.jp
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Iesaka
authors.initials: I
authors.lastname: Yoshito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Tomoo
authors.initials: T
authors.lastname: Harada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mitsuhashi
authors.forename: Kinya
authors.initials: K
authors.lastname: Shirota
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumagai
authors.forename: Norihito
authors.initials: N
authors.lastname: Nuruki
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Junichi
authors.initials: J
authors.lastname: Nitta
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D009320:Atrial Natriuretic Factor / Q000097:blood; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010138:Pacemaker, Artificial; D011788:Quality of Life; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor