AV nodal ablation and pacemaker implantation improves hemodynamic function in atrial fibrillation.
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.
Takahashi
Yoshihide
Y
Cardiovascular Division, Tsuchiura Kyoudo Hospital, Tokyo, Japan. yoshit@tf6.so-net.ne.jp
Yoshito
Iesaka
I
Takahashi
Atsushi
A
Harada
Tomoo
T
Mitsuhashi
Takeshi
T
Shirota
Kinya
K
Kumagai
Koichiro
K
Nuruki
Norihito
N
Shiraishi
Takayoshi
T
Nitta
Junichi
J
Ito
Hiroshi
H
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
D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor