title: Effect of pacing method on risk of sudden death after atrioventricular node ablation and pacemaker implantation in patients with atrial fibrillation.
abstract: BACKGROUND
  Sudden death may occur after radiofrequency catheter ablation of the atrioventricular node (AVN) and permanent pacemaker implantation. It is unclear whether a faster initial heart rate with gradual rate reduction decreases the risk of sudden death.
  
  
  OBJECTIVE
  To evaluate the effects of initial pacing at a faster rate after AVN ablation, with a gradual rate decrease over 3 months, on the rate of sudden death in patients with atrial fibrillation.
  
  
  METHODS
  We compared the rate of likely or possible procedure-related sudden death in 2 groups of patients who had AVN ablation and pacemaker implantation. The study cohort was treated between January 2005 and December 2009, and pacemakers were programmed to a lower rate of 90 beats/min after the procedure, with a monthly decrement of 10 beats/min until 60 beats/min was reached. The control group was treated between July 1990 and December 1998 when pacemakers were programmed to a lower rate of 60 beats/min immediately after ablation.
  
  
  RESULTS
  The study cohort included 520 patients (mean age 73.6 ± 10.3 years), and the control cohort comprised 334 patients (mean age 68.1 ± 1.1 years). Sudden death deemed likely or possibly related to ablation and pacemaker implantation occurred in 1 patient in the study cohort (0.2%) and in 7 patients (2.1%) in the control group (P = .007).
  
  
  CONCLUSIONS
  Sudden death was significantly decreased in the study cohort compared to controls. The faster lower pacing rate immediately after AVN ablation with a gradual decrease is a plausible mechanism for the improved clinical outcome.
authors: Department of Cardiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China.
authors: Ru-Xing
authors: RX
authors: Wang
authors: Hon-Chi
authors: HC
authors: Lee
authors: David O
authors: DO
authors: Hodge
authors: Yong-Mei
authors: YM
authors: Cha
authors: Paul A
authors: PA
authors: Friedman
authors: Robert F
authors: RF
authors: Rea
authors: Thomas M
authors: TM
authors: Munger
authors: Arshad
authors: A
authors: Jahangir
authors: Komandoor
authors: K
authors: Srivathsan
authors: Win-Kuang
authors: WK
authors: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology* / Q000601:surgery; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D003645:Death, Sudden / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate