title: Sudden death and its risk factors after atrioventricular junction ablation and pacemaker implantation in patients with atrial fibrillation.
abstract: BACKGROUND
  Although sudden death (SD) is a rare complication after atrioventricular junction (AVJ) ablation and permanent pacemaker implantation, the risk factors leading to this SD remain unknown. The purpose of this study was to investigate SD and its risk factors after ablate-and-pace strategy for rate control in atrial fibrillation (AF) patients during long-term follow-up.
  
  
  OBJECTIVE
  METHODS: From January 2005 to December 2009, we enrolled into this study 517 AF patients with AVJ ablation and right ventricular pacemaker implantation. Patients were divided into 2 groups, SD and non-SD. Cox proportional hazards models were used to assess potential risk factors for overall mortality and SD.
  
  
  RESULTS
  During a mean follow-up of 25.8 ± 18.6 months (range, 3 days to 63.8 months), 53 patients died (15 with SD). Cox proportional hazards models showed that the presence of congestive heart failure, New York Heart Association functional class, chronic renal failure, and nonsustained ventricular tachycardia were risk factors that predicted overall mortality. For SD, the presence of dilated cardiomyopathy and mitral stenosis were associated risk factors. SD was exclusively seen in patients who had narrow QRS complex or right bundle branch block prior to AVJ ablation and pacemaker implantation; SD was not seen in any patient with preexisting complete left bundle branch block.
  
  
  CONCLUSIONS
  Dilated cardiomyopathy, mitral stenosis, and baseline QRS morphology should be examined as potential risk factors for SD after AVJ ablation and pacemaker implantation.
authors.affiliation: Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, PR China.
authors.forename: Ru-Xing
authors.initials: RX
authors.lastname: Wang
authors.affiliation: Division of Cardiovascular Diseases, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hon-Chi
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, PR China.
authors.forename: Jia-Ping
authors.initials: JP
authors.lastname: Li
authors.affiliation: Division of Cardiovascular Diseases, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Cardiovascular Diseases, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Cha
authors.affiliation: Division of Cardiovascular Diseases, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Division of Cardiovascular Diseases, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Munger
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Komandoor
authors.initials: K
authors.lastname: Srivathsan
authors.affiliation: Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Behzad B
authors.initials: BB
authors.lastname: Pavri
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010138:Pacemaker, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Arrhythmia/all; Atrial fibrillation; Cardiac pacing; Catheter ablation; QRS morphology; sudden death