New or aggravated heart failure during long-term right ventricular pacing after AV junctional catheter ablation.
BACKGROUND
Atrioventricular junctional ablation (AVJA) improves symptoms and quality of life in patients with pharmacologically resistant atrial fibrillation (AF). However, long-term right ventricular stimulation has also been reported to lead to deterioration of the left ventricular function. We retrospectively analyzed the incidence of new or aggravated heart failure (HF) during long-term right ventricular stimulation following AVJA.


METHODS
Two hundred thirteen patients (110F:103M), 73 +/- 10 years old, were followed for a period of 6 +/- 3 years after AVJA. Forty-nine patients (23%) were known to have HF before AVJA. New HF was diagnosed if at least two of the following criteria were present: NYHA class >2, an LVEF <45%, and medication for HF. Aggravated HF was defined as an increase in the functional class and/or new prescription of medication for HF. All-cause death was a secondary endpoint.


RESULTS
During follow-up, 26% of the patients with known HF showed an aggravation of HF, while 13% developed new symptoms of HF. High age and low EF were independent predictors of new or aggravated HF and of new HF, while none of the tested variables predicted aggravation of known HF. The all-cause mortality was 16%, where high age and coronary artery disease were found to be independent predictors.


CONCLUSIONS
AVJA followed by right ventricular pacing was associated with aggravated HF in 23% of patients with known HF, while development of new symptoms of HF occurred much less often during follow-up (13%). The majority of patients who underwent AVJA continued to do well during long-term follow-up.
Poçi
Dritan
D
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. dritan_poci@yahoo.com
Backman
Lotta
L
Karlsson
Thomas
T
Edvardsson
Nils
N
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006352:Heart Ventricles; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology