[Left ventricular systolic function, paced QT dispersion, exercise tolerance and quality of life in long term follow up after ventricular pacemaker implantation (VVIR) and radiofrequency atrioventricular junction ablation in drug refractory atrial fibrillation].
THE AIM OF THE STUDY was to analyze left ventricular systolic function and dimensions, paced QT dispersion (QTD), exercise tolerance (six minute walk test- M6) and quality of life (QOL) after RFAVJ in a 6-month (6m) and a 24-month (24m) follow-up.


METHODS
RFAVJ was performed in 30 pts (18 men and 12 women) aged from 43 to 81 years (mean age 69.8+/-11.3). AF was first diagnosed from 2 to 9 (mean 5+/-2.1) years prior to ablation. All patients received VVIR pacemakers. Pacing rate was programmed at 80 bpm. Prior to RFAVJ all patients underwent: transthoracic echocardiography (ECHO) to assess the left ventricular ejection fraction (EF), ventricular end-diastolic and end-systolic dimension (LVDD, RVDD, LVSD, respectively) and left atrial dimension; QOL assessment based on self-evaluation using: a questionnaire of the SF-36, Manolis, DASI scale. M6 on flat surface. These examinations were repeated at 6m and 24m after ablation. The maximum QT interval (QTM), minimum QT interval (QTm) and QTD were measured from the 12-lead ECG after RFAVJ on the first day (1d) and at 6m, 24m following RFAVJ.


RESULTS
SF total increased from 73.4 to 96.3 (p < 0.0025) in 6m, and to 113.8 (ns) in 24m, symptomatic score from 15.7 to 20.8 (p < 0.025) in 6m, and to 22.4 (ns) in 24m, DASI from 39.3 to 46.1 (p < 0.01) in 6m and decreased to 23.9 (p < 0.001) in 24m. Any significant changes in EF and the remaining ECHO parameters in 6m were observed. At 24 m we found significant decreased in EF (p < 0.01) and increased in LVSD (p < 0.05). Parameters of the M6 significantly improved. A significant correlation was observed between the SF-36 and functional symptomatology and DASI in 6m. The mean QTm, QTM and QTD were unchanged.


CONCLUSIONS
1. In pts with drug refractory AF, RFAVJ and VVIR significantly improve QOL and M6. 2. At long term follow up a significant decrease in EF and increase in LVSD were demonstrated. 3. No significant changes in the paced QT and QTD were observed.
Lelakowski
Jacek
J
Collegium Medicum Uniwersytetu Jagiellońskiego, Klinika Elektrokardiologii, Instytut Kardiologii, Krakowski Szpital Specjalistyczny. jlelakow@szpitaljp2.krakow.pl
Małecka
Barbara
B
Bednarek
Jacek
J
Bigaj
Jolanta
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery; D017115:Catheter Ablation; D004351:Drug Resistance; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011788:Quality of Life; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D016277:Ventricular Function, Left / Q000502:physiology*