title: Mortality After Atrioventricular Nodal Radiofrequency Catheter Ablation With Permanent Ventricular Pacing in Atrial Fibrillation: Outcomes From a Controlled Nonrandomized Study.
abstract: Atrioventricular nodal radiofrequency ablation (AVNA) with permanent ventricular pacing can be used to control rate in patients with atrial fibrillation (AF). However, long-term outcomes after AVNA are uncertain, especially in light of irreversible pacemaker dependence.
  
  
  
  We examined 9122 consecutive patients with AF. The outcomes in 453 patients with AVNA (26% of whom underwent an implantable cardiac defibrillator implant and 37% underwent cardiac resynchronization therapy implant) were compared with AF patients without AVNA after propensity score 1:1 matching. During follow-up in the propensity-matched cohort (2.41±3.23 years, median 1.23, quartiles 0.33-3.12), 100 patients died (yearly rate of death 6.6%). Mode of death was available in 86% of patients, which was cardiovascular in 67% of the patients (related to heart failure in 38%, sudden death in 5%, and other cardiovascular reason in 24%) and noncardiovascular in 33%. AVNA in patients with AF was associated with a lower risk of mortality (odds ratio 0.47, 95% confidence interval, 0.29-0.77; P=0.003), a lower risk of cardiovascular mortality (odds ratio =0.41, 95% confidence interval 0.23-0.73; P=0.003), and nonsignificant lower risk of stroke and thromboembolic events (odds ratio =0.61, 95% confidence interval 0.36-1.06; P=0.08).
  
  
  
  In sick AF patients with multiple comorbidities, AVNA with permanent ventricular pacing for rate control seems safe during follow-up and may be associated with lower mortality.
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Bruno
authors.initials: B
authors.lastname: Garcia
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Clementy
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Nazih
authors.initials: N
authors.lastname: Benhenda
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pierre
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.).
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.affiliation: From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.). lfau@med.univ-tours.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002423:Cause of Death; D015897:Comorbidity; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D057216:Propensity Score; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ablation; atrial fibrillation; atrioventricular nodal radiofrequency ablation; heart failure; prognosis; sudden death