title: [Long-term follow-up after catheter-ablation of atrioventricular junction and pacemaker implantation in patients with uncontrolled atrial fibrillation and heart failure].
abstract: BACKGROUND
  Atrioventricular (AV) junction ablation coupled with pacemaker implantation is an effective therapeutic option for rate control in atrial fibrillation (AF) and heart failure (HF). However, there is controversy regarding the long-term outcome of the procedure, since right ventricular stimulation can lead to left ventricular remodelling and HF.
  
  
  OBJECTIVE
  The aim of the study was to determine a 5-year outcome of the procedure on survival, HF control and myocardial function in patients with HF and uncontrolled AF.
  
  
  METHODS
  All patients with AF and HF who underwent AV-junction ablation with pacemaker implantation in our institution were followed after the procedure. HF diagnosis was established if > or = 2 of the following criteria were present: 1) ejection fraction (EF) < or = 45%; 2) previous episode of congestive HF (CHF); 3) NYHA-class > or = 2; and 4) use of drug-therapy for HF.
  
  
  RESULTS
  Study included 32 patients (25 males; 53.4 +/- 9.6 years). The mean heart rate was 121 +/- 25 bpm before and 75 +/- 10 bpm after ablation (p=0.001). Over the follow-up of 5.0 +/- 4.0 years nine patients (28.1%) died (five died suddenly, three of terminal CHF and one of stroke). After the procedure, CHF occurrence was reduced (p=0.001), as well as the annual number of hospitalizations (p=0.001) and the number of drugs for CHF (p=0.028). In addition, NYHA-class and EF were improved, from 3.3 +/- 0.7 to 1.6 +/- 0.8 (p<0.001) and from 39 +/- 11% to 51 +/- 10% (p<0.001), respectively.
  
  
  CONCLUSIONS
  In HF patients with uncontrolled AF, 5-year mortality after AV-junction ablation and pacemaker implantation was 28%. In the majority of these patients good rate of AF and HF control were achieved, as well as the improvement of functional status and myocardial contractility.
authors: Nebojša
authors: N
authors: Mujović
authors: Miodrag
authors: M
authors: Grujić
authors: Stevan
authors: S
authors: Mrdja
authors: Aleksandar
authors: A
authors: Kocijančić
authors: Goran
authors: G
authors: Milašinović
authors: Velibor
authors: V
authors: Jovanović
authors: Žarko
authors: Ž
authors: Čalović
authors: Siniša
authors: S
authors: Pavlović
authors: Petar
authors: P
authors: Stojanov
authors: Srdjan
authors: S
authors: Raspopović
authors: Nataša
authors: N
authors: Mujović
authors: Bosiljka
authors: B
authors: Vujisić-Tešić
authors: Milan
authors: M
authors: Petrović
authors: Olga
authors: O
authors: Petrović
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial