title: Safety and efficacy of radiofrequency energy catheter ablation of atrial fibrillation in patients with pacemakers and implantable cardiac defibrillators.
abstract: BACKGROUND
  Catheter ablation has significantly transformed the clinical management of atrial fibrillation (AF). The safety and efficacy of this procedure are not well understood in patients with pacemakers and defibrillators.
  
  
  OBJECTIVE
  The purpose of this study was to study the impact of radiofrequency catheter ablation of AF in patients with pacemakers and implantable cardiac defibrillators.
  
  
  METHODS
  We studied 86 patients with pacemakers and defibrillators (group I) and a similar number of age- and gender-matched controls (group II) who underwent AF ablation between 1999 and 2004. Clinical and procedural variables were compared between the two groups. In group I, various generator and lead parameters were compared before and after the procedure. Resurgence of clinical AF after 2 months was considered recurrence.
  
  
  RESULTS
  Both groups were similar with regard to age, gender, body mass index, and type of AF. Group I had a higher incidence of diabetes (17% vs 6%, P = .03), coronary artery disease (25% vs 13%, P = .05), less prolonged AF (31 +/- 21 vs 45 +/- 30 months, P <.001), lower left ventricular ejection fraction (49 +/- 13% vs 52 +/- 9%, P = .03), and left ventricular end-diastolic dimensions (4.97 +/- 0.81 vs 4.72 +/- 0.67, P = .03). No changes in the sensing and pacing thresholds, impedance of atrial and ventricular leads, or defibrillator coil impedance after AF ablation were observed in group I. Atrial lead dislodgment was seen in two patients. Transient abnormal but "expected" pulse generator behavior was seen in 25% of patients without permanent malfunction. Stroke (1% vs 1%, P = 1.000), pulmonary vein stenosis (2% vs 1%, P = .77), and AF recurrence rates at 12 months were similar between groups I and II, respectively (19% vs 21%, P = .73).
  
  
  CONCLUSIONS
  AF ablation is safe and efficacious in patients with pacemakers and defibrillators.
authors.affiliation: Cleveland Clinic Foundation, OH 44185, USA.
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Kay
authors.initials: K
authors.lastname: Ryschon
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhateja
authors.forename: Mihir
authors.initials: M
authors.lastname: Bhakru
authors.forename: Sergio
authors.initials: S
authors.lastname: Thal
authors.forename: Atul
authors.initials: A
authors.lastname: Verma
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.forename: Subramanya
authors.initials: S
authors.lastname: Prasad
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cummings
authors.forename: William
authors.initials: W
authors.lastname: Belden
authors.forename: David
authors.initials: D
authors.lastname: Burkhardt
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: Mina
authors.initials: M
authors.lastname: Chung
authors.forename: Bruce
authors.initials: B
authors.lastname: Wilkoff
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000628:therapy*; D016022:Case-Control Studies; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D012008:Recurrence; D012449:Safety