title: Total atrioventricular nodal ablation increases atrial fibrillation burden in patients with paroxysmal atrial fibrillation despite continuation of antiarrhythmic drug therapy.
abstract: BACKGROUND
  Total atrioventricular nodal (TAVN) ablation and pacing is an accepted and safe treatment for patients with drug-refractory paroxysmal atrial fibrillation (AF). Many patients develop permanent AF within the first 6 months after TAVN ablation. This usually is ascribed to the cessation of antiarrhythmic drug therapy. We hypothesized that TAVN ablation itself creates an atrial substrate prone to AF.
  
  
  RESULTS
  Patients participating in the Atrial Pacing Periablation for Paroxysmal Atrial Fibrillation (PA3) study who remained on stable antiarrhythmic drug therapy throughout follow-up were included in this analysis. AF burden and the development of persistent AF in the preablation period were compared to two consecutive postablation periods. Echocardiographic changes also were evaluated. Twenty-two patients remained on stable drug therapy (9 men and 13 women, age 59 +/- 3 years). One patient developed persistent AF preablation compared to 10 postablation (P < 0.05). AF burden preablation was 3.0 +/- 1.2 hours/day and increased to 10.4 +/- 2.2 hours/day and 11.8 +/- 2.3 hours/day in the two postablation follow-up periods (P < 0.05). In patients with fractional shortening (FS) >30% prior to ablation, FS decreased significantly from 39.4% +/- 1.3% to 36.4%+/- 1.7% (P < 0.05). In contrast, in patients with a FS < or =30% prior to ablation, FS increased from 27% +/- 0.8% to 33.6 +/- 1.7% (P < 0.05).
  
  
  CONCLUSIONS
  TAVN ablation increases AF burden and facilitates the development of persistent AF in patients with paroxysmal AF despite the continuation of antiarrhythmic drugs. Loss of AV and/or interventricular synchrony may lead to altered cardiac hemodynamics resulting in atrial stretch and increasing AF burden.
authors.affiliation: Division of Cardiology, University of Calgary, AB, Canada.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.forename: D George
authors.initials: DG
authors.lastname: Wyse
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gillis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D001283:Atrioventricular Node / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D000889:Anti-Arrhythmia Agents