Pulmonary vein antrum isolation, atrioventricular junction  ablation, and antiarrhythmic drugs combined with direct  current cardioversion: survival rates at 7 years follow-up.
OBJECTIVE
To report survival rates in patients treated with pulmonary vein antrum isolation (PVAI), atrioventricular junctional ablation (AVJA), and antiarrhythmic and direct current cardioversion (A+DCCV) at 7 years follow-up.


METHODS
From February 2002-December 2004, 1,000 consecutive patients underwent PVAI or A+DCCV or AVJA. These patients were matched in a nested casecontrolled methodology. Survival rates were compared at the end of 7 years.


RESULTS
Three hundred and forty-five consecutive patients had undergone PVAI (34.5%), 157 (15.7%) consecutive patients AVJA, and 498(49.8%) A+DCCV. After matching the patients in a nested case-controlled methodology, 146 (32.3%) patients were in the PVAI group, 205 (59.4%) in the A+DCCV, and 101 (22.3%) in the AVJA. At 69+/-27 months, 63 (13.9%) patients had died in the matched population. Three (2.1%) patients died in the PVAI group, 34 (16.5%) in the A+DCCV group, and 26 (25.7%) in the AVJA group. In multivariable analysis, treatment strategy was a significant predictor of mortality. Compared to patients with PVAI (reference group), those with A+ DCCV (HR 4.9, p=0.011) and AVJA (HR 10.6, p=0.001) procedures had higher mortality risk.


CONCLUSIONS
Compared to the other two procedures, patients with PVAI had the best survival rates at the end of 7 years. However, the observational case-control design of this study incurs the potential for confounding due to nonrandomized treatment selection, and creates a major limitation in making valid generalization of the findings.
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
Kai
K
Sonne
Dimpi
D
Patel
Prasant
P
Mohanty
Luciana
L
Armaganijan
Lucie
L
Riedlbauchova
Moataz
M
El-Ali
Luigi
L
Di Biase
Preeti
P
Venkatraman
Mazen
M
Shaheen
Marketa
M
Kozeluhova
Robert
R
Schweikert
J David
JD
Burkhardt
Robert
R
Canby
Oussama
O
Wazni
Walid
W
Saliba
Andrea
A
Natale
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000401:mortality* / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004554:Electric Countershock / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents