title: Atrioventricular nodal ablation versus antiarrhythmic drugs after permanent pacemaker implantation for bradycardia-tachycardia syndrome.
abstract: Patients often require antiarrhythmic drugs to control tachycardia after permanent pacemaker implantation (PMI) for bradycardia-tachycardia syndrome. We compared atrioventricular nodal ablation (AVNA) to antiarrhythmic drugs after PMI for bradycardia-tachycardia syndrome. Twenty-eight symptomatic patients with bradycardia-tachycardia syndrome, all of which had a long pause after termination of paroxysmal atrial fibrillation, underwent PMI with RV lead placement at the mid-septum site. Among these patients, 14 underwent PMI and AVNA (AVNA group). The remaining 14 patients underwent PMI only, and continued to take anti-arrhythmic drugs (drug group). We compared cardiac function (cardio-thoracic ratio on chest X-ray, left atrial diameter, left ventricular end-diastolic dimension, and left ventricular-ejection fraction by echocardiography), exercise tolerance (6-min walking distance), symptoms, and the number of antiarrhythmic drugs just before and 6 months after PMI. Baseline characteristics were similar between the two groups, except for the number of antiarrhythmic drugs. Six months after PMI, cardiac function, exercise tolerance, and symptoms did not differ significantly between the two groups. Compared to the drug group (p < 0.01), the number of antiarrhythmic drugs was significantly smaller in the AVNA group 6 months after PMI. Patients who underwent AVNA concurrently with PMI with RV lead placement at the mid-septum site for bradycardia-tachycardia syndrome were able to reduce the intake of drugs and improve their tachycardia-related symptoms while maintaining cardiac function and exercise tolerance.
authors.affiliation: Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Nagamoto
authors.forename: Tomohito
authors.initials: T
authors.lastname: Inage
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Yoshida
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Takeki
authors.initials: T
authors.lastname: Gondo
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Eiichi
authors.initials: E
authors.lastname: Takii
authors.forename: Kenta
authors.initials: K
authors.lastname: Murotani
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Imaizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D001919:Bradycardia / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D010138:Pacemaker, Artificial; D020127:Recovery of Function; D013577:Syndrome; D013610:Tachycardia / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000889:Anti-Arrhythmia Agents