(Circulation. 1999;99:1587-1592.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Prospective Randomized Study of Ablation and Pacing Versus Medical Therapy for Paroxysmal Atrial Fibrillation
Effects of Pacing Mode and Mode-Switch Algorithm
From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK.
Correspondence to Dr H.J. Marshall, Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. E-mail h.j.marshall{at}bham.ac.uk
Background—Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.
Methods and Results—Symptomatic patients who had
tried 
2 drugs for PAF were randomized to continue medical therapy
(n=19) or AV junction ablation and implantation of dual-chamber
mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast
algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals
and used quality-of-life questionnaires (Psychological General Well
Being [PGWB], McMaster Health Index [MHI], cardiac symptom score),
exercise testing, echocardiography, and Holter
monitoring. Paced patients were randomized to DDDR/MS or VVIR and
subsequently crossed over. Ablation and DDDR/MS pacing produced better
scores than drug therapy for overall symptoms (-41%,
P<0.01), palpitations (-58%,
P=0.0001), and dyspnea (-37%, P<0.05).
Changes in score from baseline were better with ablation and DDDR/MS
pacing for overall symptoms (-48% versus -4%,
P<0.005), palpitation (-62% versus -5%,
P<0.001), dyspnea (-44% versus -3%,
P<0.005), and PGWB (+12% versus +0.5%,
P<0.05). DDDR/MS was better than VVIR pacing for
overall symptoms (-21%, P<0.05), dyspnea (-30%,
P<0.005), and MHI (+5%, P<0.03). There
were no differences between algorithms. More patients developed
persistent AF with ablation and pacing than with drugs at 6 weeks (12
of 37 versus 0 of 19, P<0.01).
Conclusions—Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.
Key Words: fibrillation • catheter ablation • atrioventricular node • pacing • antiarrhythmia agents
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