[The influence of radiofrequency (RF) ablation of the atrioventricular junction in atrial fibrillation on left ventricular systolic function, exercise tolerance and quality of life].
In patients with drug refractory atrial fibrillation radiofrequency (RF), ablation of the atrioventricular (AV) junction and pacemaker implantation is an alternative procedure. The aim of this study was to assess the left ventricular systolic function, exercise tolerance and quality of life (QOL) in patients who underwent RF AV junction ablation and permanent pacemaker implantation.


METHODS
24 patients (14 male, 10 female, 64.8 +/- 11.0 years) underwent RF ablation. The duration of symptoms was 4 +/- 1.9 years prior to ablation. Post ablation, the selected pacing mode was DDDR for the 4 patients with paroxysmal AF and VVIR for the 20 patients with chronic AF. The underlying heart disease was coronary artery disease (17 CAD), arterial hypertension (15 AH) and heart failure (9 HF). Prior to the ablation and after 6 months follow-up--an ECHO, exercise tolerance (the six minute walk -M6) and QOL assessment (the questionnaire of SF-36, functional symptomatology scale, DASI scale) were performed. The NYHA class was also evaluated.


RESULTS
The patients showed a significant improvement in NYHA class (p < 0.005), in QOL (SF-36, p < 0.0025; symptomatic score, p < 0.025; DASI, p < 0.01) and in the M6 (p < 0.01). We did not find significant changes in left ventricular performance. The significant correlation was observed between the SF-36 and functional symptomatology (r = 0.71) and DASI (r = 0.53). We divided our patients into two groups: Group A (patients with the higher NYHA class, p < 0.025) with significant improvement QOL and Group B with insignificant improvement of QOL. Post ablation in group A we--observed significant improvement in NYHA class and M6 (p < 0.01).


CONCLUSIONS
1. In patients with drug refractory atrial fibrillation, RF AV junction ablation and permanent pacemaker implantation significantly improve the QOL, M6 and NYHA class. 2. Significant improvement of QOL as well as in M6 can be expected after RF ablation with pacemaker implantation, especially in patients with more advanced hart failure (higher NYHA class).
Lelakowski
Jacek
J
Klinika Elektrokardiologii Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowskim, Szpitalu Specjalistycznym im. Jana Pawła II, Kraków. jlelakow@szpitaljp2.krakow.pl
Majewski
Jacek
J
Bigaj
Jolanta
J
Szczepkowski
Jacek
J
Dreher
Adam
A
Bednarek
Jacek
J
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery; D017115:Catheter Ablation; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left