Safety and efficacy of radiofrequency energy catheter ablation of atrial fibrillation in patients with pacemakers and implantable cardiac defibrillators.
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.
Lakkireddy
Dhanunjaya
D
Cleveland Clinic Foundation, OH 44185, USA.
Patel
Dimpi
D
Ryschon
Kay
K
Bhateja
Rohit
R
Bhakru
Mihir
M
Thal
Sergio
S
Verma
Atul
A
Wazni
Oussama
O
Kilicaslan
Fethi
F
Kondur
Ashok
A
Prasad
Subramanya
S
Cummings
Jennifer
J
Belden
William
W
Burkhardt
David
D
Saliba
Walid
W
Schweikert
Robert
R
Bhargava
Mandeep
M
Chung
Mina
M
Wilkoff
Bruce
B
Tchou
Patrick
P
Natale
Andrea
A
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