From the Department of Cardiology and Arrhythmologic Center, Ospedali
Riuniti, Lavagna (M.B., L.G.); the Department of Cardiology and Arrhythmologic
Center, Ospedale S Maria Nuova, Reggio Emilia (C.M., N.B., G.L.); and the
Section of Arrhythmology, Ospedale Civile, Imperia (G.M., R.M.).
Correspondence to Michele Brignole, MD, Via A Grilli 164, 16041 Borzonasca (GE), Italy. E-mail brignole{at}omninet.it
Background—Uncontrolled studies have
suggested that atrioventricular junction ablation and
pacemaker implantation have beneficial effects on quality of life in
patients with chronic atrial fibrillation (AF).
Methods and Results—We performed a multicenter, controlled,
randomized, 12-month evaluation of the clinical effects of
atrioventricular junction ablation and VVIR pacemaker
(Abl+Pm) versus pharmacological (drug) treatment in 66 patients with
chronic (lasting >6 months) AF who had clinically manifest heart
failure and heart rate >90 bpm on 3 standard ECGs recorded at rest
during stable clinical conditions on different days. Before
completion of the study, withdrawals occurred in 8 patients
of the drug group and in 4 patients of the Abl+Pm group. At the end of
the 12 months, the 28 Abl+Pm patients who completed the study showed
lower scores in palpitations (-78%; P=0.000) and
effort dyspnea (-22%; P=0.05) than the 26 of the drug
group. Lower scores, although not significant, were also observed for
exercise intolerance (-20%), easy fatigue (-17%), chest discomfort
(-50%), Living with Heart Failure Questionnaire (-14%), New York
Heart Association functional classification (-4%), and Activity scale
(-12%). The intrapatient comparison between enrollment and month 12
showed that in the Abl+Pm group, all variables except easy fatigue
improved significantly from 14% to 82%. However, because an
improvement was also observed in the drug group, the difference between
the 2 groups was significant only for palpitations
(P=0.000), effort dyspnea (P=0.01),
exercise intolerance (P=0.005), easy fatigue
(P=0.02), and chest discomfort (P=0.02).
Cardiac performance, evaluated by means of standard
echocardiogram and exercise test, did not differ significantly between
the 2 groups and remained stable over time.
Conclusions—In patients with heart failure and chronic AF, Abl+Pm
treatment is effective and superior to drug therapy in controlling
symptoms, although its efficacy appears to be less than that observed
in uncontrolled studies because some improvement can also be expected
in medically treated patients. Cardiac performance is not
modified by the treatment.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Assessment of Atrioventricular Junction Ablation and VVIR Pacemaker Versus Pharmacological Treatment in Patients With Heart Failure and Chronic Atrial Fibrillation
A Randomized, Controlled Study
Key Words: catheter ablation • atrioventricular node • fibrillation • pacemakers
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