title: Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Taipei Medical University, School of Medicine, Taipei Wan-Fang Hospital, Taipei, Taiwan.
authors.forename: Ming-Hsiung
authors.initials: MH
authors.lastname: Hsieh
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Tai
authors.forename: Shih-Huang
authors.initials: SH
authors.lastname: Lee
authors.forename: Huan-Ming
authors.initials: HM
authors.lastname: Tsao
authors.forename: Yung-Kuo
authors.initials: YK
authors.lastname: Lin
authors.forename: Jin-Long
authors.initials: JL
authors.lastname: Huang
authors.forename: Paul
authors.initials: P
authors.lastname: Chan
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Chen
authors.forename: Jen-Yuan
authors.initials: JY
authors.lastname: Kuo
authors.forename: Ta-Chuan
authors.initials: TC
authors.lastname: Tuan
authors.forename: Tsui-Lieh
authors.initials: TL
authors.lastname: Hsu
authors.forename: Chi-Woon
authors.initials: CW
authors.lastname: Kong
authors.forename: Shih-Lin
authors.initials: SL
authors.lastname: Chang
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
mesh_terms: 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