Long-term follow-up after catheter-ablation of atrioventricular junction and pacemaker implantation in patients with uncontrolled atrial fibrillation and heart failure

Abstract

Introduction. Atrioventricular (AV) junction ablation coupled with pacemaker implantation is an effective therapeutic option for rate control in atrial fibrillation (AF) and heart failure (HF). However, there is controversy regarding the long-term outcome of the procedure, since right ventricular stimulation can lead to left ventricular remodelling and HF. Objective. The aim of the study was to determine a 5-year outcome of the procedure on survival, HF control and myocardial function in patients with HF and uncontrolled AF. Methods. All patients with AF and HF who underwent AV-junction ablation with pacemaker implantation in our institution were followed after the procedure. HF diagnosis was established if ≥2 of the following criteria were present: 1) ejection fraction (EF) ≤45%; 2) previous episode of congestive HF (CHF); 3) NYHA-class ≥2; and 4) use of drug-therapy for HF. Results. Study included 32 patients (25 males; 53.4±9.6 years). The mean heart rate was 121±25 bpm before and 75±10 bpm after ablation (p=0.001). Over the follow-up of 5.0±4.0 years nine patients (28.1%) died (five died suddenly, three of terminal CHF and one of stroke). After the procedure, CHF occurrence was reduced (p=0.001), as well as the annual number of hospitalizations (p=0.001) and the number of drugs for CHF (p=0.028). In addition, NYHA-class and EF were improved, from 3.3±0.7 to 1.6±0.8 (p<0.001) and from 39±11% to 51±10% (p<0.001), respectively. Conclusion. In HF patients with uncontrolled AF, 5-year mortality after AV-junction ablation and pacemaker implantation was 28%. In the majority of these patients good rate of AF and HF control were achieved, as well as the improvement of functional status and myocardial contractility.

Keywords

• atrial fibrillation
• heart failure
• catheter-ablation
• AV junction ablation
• tachycardiomyopathy