Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation.
BACKGROUND
Catheter ablation of atrial fibrillation (AF) has become another nonpharmacologic therapeutic option for medically refractory paroxysmal AF. Whether this method is better than atrioventricular (AV) junction ablation plus pacing therapy is unknown. The purpose of this study was to compare the very long-term (longer than 4 years) clinical outcomes of the 2 methods in elderly patients (>65 years old) with medically refractory paroxysmal AF.


METHODS
From January 1995 to December 2001, 71 elderly patients with medically refractory paroxysmal AF were included; group 1 included 32 patients with successful AV junction ablation plus pacing therapy and group 2, 37 patients with successful catheter ablation of AF.


RESULTS
After a mean follow-up of more than 52 months, the AF was better controlled in the group 1 patients than group 2 (100% vs 81%, P = 0.013), however, they had a significantly higher incidence of persistent AF (69% vs 8%, P < 0.001) and heart failure (53% vs 24%, P = 0.001). Furthermore, the incidence of ischemic stroke and cardiac death was similar between the 2 groups. Compared with the preablation values, a significant increase in the NYHA functional class (1.7 +/- 0.9 vs 1.4 +/- 0.7, P = 0.01) and significant decrease in the left ventricular ejection fraction (44 +/- 8% vs 51 +/- 10%, P = 0.01) were noted in the group 1 patients, but not in the group 2 patients.


CONCLUSIONS
Although AV junction ablation plus pacing therapy better controlled the AF in elderly patients with medically refractory paroxysmal AF, that method was associated with a higher incidence of persistent AF and heart failure than catheter ablation of AF in the very long-term follow-up.
Hsieh
Ming-Hsiung
MH
Division of Cardiovascular Medicine, Department of Medicine, Taipei Medical University, School of Medicine, Taipei Wan-Fang Hospital, Taipei, Taiwan.
Tai
Ching-Tai
CT
Lee
Shih-Huang
SH
Tsao
Huan-Ming
HM
Lin
Yung-Kuo
YK
Huang
Jin-Long
JL
Chan
Paul
P
Chen
Yi-Jen
YJ
Kuo
Jen-Yuan
JY
Tuan
Ta-Chuan
TC
Hsu
Tsui-Lieh
TL
Kong
Chi-Woon
CW
Chang
Shih-Lin
SL
Chen
Shih-Ann
SA
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D002544:Cerebral Infarction / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome