(Circulation. 2000;102:736.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Randomized Crossover Comparison of DDDR Versus VDD Pacing After Atrioventricular Junction Ablation for Prevention of Atrial Fibrillation
From the Division of Cardiology, Foothills Hospital and the University of Calgary, Calgary, Alberta, Canada (A.M.G., M.S.R., D.G.W.); Hamilton General Hospital and McMaster University, Hamilton, Ontario, Canada (S.J.C.); Hôpital Notre Dame and the University of Montreal, Montreal, Quebec, Canada (P.L.); Hôpital Laval and Laval University, Quebec City, Canada (F.P.); Montreal Heart Institute and the University of Montreal, Montreal, Quebec, Canada (M.D.); St Paul’s Hospital and University of British Columbia, Canada (C.R.K.); University Hospital and the University of Western Ontario, London, Ontario, Canada (R.Y.); St Michael’s Hospital and the University of Toronto, Toronto, Ontario, Canada (D.N.); University Hospital and the University of Alberta, Edmonton, Alberta, Canada (K.M.K.); Queen Elizabeth II Medical Centre and Dalhousie University, Halifax, Nova Scotia, Canada (M.J.G.); and Hôpital du Sacre Coeur and the University of Montreal, Canada (T.K.).
Correspondence to Anne M. Gillis, MD, Division of Cardiology, The University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada T2N 4N1. E-mail amgillis{at}ucalgary.ca
Background—Some clinical data suggest that atrial-based pacing prevents paroxysmal atrial fibrillation (AF). This study tested the hypothesis that DDDR pacing compared with VDD pacing prevents AF after atrioventricular (AV) junction ablation.
Methods and Results—Patients were randomized to DDDR pacing (n=33) or to VDD pacing (n=34) after AV junction ablation and followed every 2 months for 6 months. Patients then crossed over to the alternate pacing mode and were followed for an additional 6 months. Primary analysis included the time to first recurrence of sustained AF (duration >5 minutes), total AF burden, and the development of permanent AF. The time to first episode of AF was similar in the DDDR group (0.37 days, 95% CI 0.1 to 1.3 days) and the VDD pacing group (0.5 days, 95% CI 0.2 to 1.7 days, P=NS). AF burden increased over time in both groups (P<0.01). At the 6-month follow-up, AF burden was 6.93 h/d (95% CI 4.37 to 10.96 h/d) in the DDDR group and 6.30 h/d (95% CI 3.99 to 9.94 h/d) in the VDD group (P=NS). Twelve (35%) patients in the DDDR group and 11 (32%) patients in the VDD group had permanent AF within 6 months of ablation. Within 1 year of follow-up, 43% of patients had permanent AF.
Conclusions—DDDR pacing compared with VDD pacing does not prevent paroxysmal AF over the long term in patients in the absence of antiarrhythmic drug therapy after total AV junction ablation. Many patients have permanent AF within the first year after ablation.
Key Words: fibrillation • pacemakers • ablation • atrioventricular node
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