title: Comparison of different approaches to atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation.
abstract: BACKGROUND
  To compare the feasibility and efficiency of atrioventricular junction (AVJ) ablation and device implantation in patients with drug-refractory atrial fibrillation using three different approaches.
  
  
  METHODS
  Sixty-nine patients (57% male; age 72 ± 10; ejection fraction 45 ± 15%) undergoing device implantation and AVJ ablation were retrospectively studied at a tertiary referral center. In 20 patients (29%) AVJ ablation was performed via the femoral vein immediately following device implantation (group 1), whereas 33 patients (48%) underwent a staged procedure with AVJ ablation via the femoral vein >3 weeks after device implantation (group 2). In a third group of 16 patients (23%), AVJ ablation was performed during device implantation through the pocket using the same axillary vein access site (group 3). The main outcome measures were: procedure time, fluoroscopy time, laboratory occupancy time, and success rate.
  
  
  RESULTS
  There was a significant difference in procedure time (118 ± 45 minutes. in group 1, 133 ± 32 minutes in group 2, and 87 ± 26 minutes in group 3, P < 0.001) and the laboratory occupancy time (175 ± 48 minutes in group 1, 200 ± 32 minutes in group 2, and 121 ± 27 minutes in group 3, P < 0.001). There was no difference in fluoroscopy time (group 1: 20 ± 15 minutes, group 2: 27 ± 22 minutes, and group 3: 24 ± 9 minutes P = 0.4). The procedure was successfully completed in all patients, but cross-over to a femoral approach was required in one patient in group 3.
  
  
  CONCLUSIONS
  The alternative approach of AVJ ablation during permanent pacemaker implantation from the same axillary vein access site is feasible and more efficient compared to the femoral approach.
authors.affiliation: Department of Cardiology/Electrophysiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Nisha
authors.initials: N
authors.lastname: Arenja
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.forename: Beat
authors.initials: B
authors.lastname: Schaer
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Nikola
authors.initials: N
authors.lastname: Pavlovic
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies
keywords: alternative approach; atrial fibrillation; atrioventricular junction ablation; axillary vein access site; pacemaker implantation