title: Two-Year Follow-up in Atrial Fibrillation Patients Referred for Catheter Ablation of the Atrioventricular Node.
abstract: BACKGROUND
  At the present time there is still concern regarding the long-term deleterious effects of right ventricular apical pacing in patients referred for auriculoventricular node ablation (AVNA). Furthermore, scarce information is available regarding differences in the follow up according to the baseline cardiopathy and predictors associated with a worse outcome.
  
  
  METHODS
  104 consecutives patients referred for AVNA were retrospectively analyzed. Patients included were seen in the outpatient clinic at 6, 12 and 24 months post ablation (mean follow-up 24 ± 2 months). An echocardiogram two years after the procedure was obtained in 68 patients. Three categories were done according to the change in the left ventricular function (LVEF) (increase, decrease or absence of change, defined as less than 10% variation in either LVEF).
  
  
  RESULTS
  After two years of follow up there was a decrease in the rate of hospital admission (from 0.9 admission/year to 0.35, p<0.001), an increase in the functional status in at least one NYHA class in 58 patients, and an increase in the global LVEF (from 48.9% to 54,1%; p<0.001). Valvular replacement and LVEF less than 50% were independently associated with a decrease in the LVEF. Regarding safety issues, one patient who presented a polymorphic ventricular tachycardia (Torsade de pointes) 60 minutes after the ablation.
  
  
  CONCLUSIONS
  AVNA results in a decrease in hospital admission rates and an improvement in functional status. Baseline LVEF < 50% and mitral valvulopathy were multivariate predictor of LVEF decline, hence, it is our belief that, in this particular population, the "ablate and pace" strategy is not the most suitable option, and or maybe a biventricular pacemaker should be implanted or an AF ablation reconsidered." Finally, although it is a safe procedure and rate of complications were low, there is a potential risk of fatal complications.
authors.affiliation: Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pujol Salvador
authors.affiliation: Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Sande
authors.affiliation: Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Macías Gallego
authors.affiliation: Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain.
authors.forename: Xulio
authors.initials: X
authors.lastname: A Fernández-López
authors.affiliation: Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: José Gavira-Gómez
authors.affiliation: Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Seara
authors.affiliation: Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain.
authors.forename: Naira
authors.initials: N
authors.lastname: Calvo
authors.affiliation: Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Cardiovascular Department Hospital Clínico Universitario Santiago de Compostela, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
authors.affiliation: Cardiovascular Department Clínica Universidad de Navarra.Pamplona. Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Bolao
keywords: Biventricular Pacing; Catheter Ablation of the Atrioventricular Node; Right Ventricular Pacing; Ventricular Tachycardia