Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation

Ming Hsiung Hsieh, Ching Tai Tai, Shih Huang Lee, Huan Ming Tsao, Yung Kuo Lin, Jin Long Huang, Paul Chan, Yi Jen Chen, Jen Yuan Kuo, Ta Chuan Tuan, Tsui Lieh Hsu, Chi Woon Kong, Shih Lin Chang, Shih Ann Chen

Research output: Contribution to journalArticle

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Abstract

Background: Catheter ablation of atrial fibrillation (AF) has become another nonpharmacologic therapeutic option for medically refractory paroxysmal AF. Whether this method is better than atrioventricular (AV) junction ablation plus pacing therapy is unknown. The purpose of this study was to compare the very long-term (longer than 4 years) clinical outcomes of the 2 methods in elderly patients (>65 years old) with medically refractory paroxysmal AF. Methods: From January 1995 to December 2001, 71 elderly patients with medically refractory paroxysmal AF were included; group 1 included 32 patients with successful AV junction ablation plus pacing therapy and group 2, 37 patients with successful catheter ablation of AF. Results: After a mean follow-up of more than 52 months, the AF was better controlled in the group 1 patients than group 2 (100% vs 81%, P = 0.013), however, they had a significantly higher incidence of persistent AF (69% vs 8%, P <0.001) and heart failure (53% vs 24%, P = 0.001). Furthermore, the incidence of ischemic stroke and cardiac death was similar between the 2 groups. Compared with the preablation values, a significant increase in the NYHA functional class (1.7 ± 0.9 vs 1.4 ± 0.7, P = 0.01) and significant decrease in the left ventricular ejection fraction (44 ± 8% vs 51 ± 10%, P = 0.01) were noted in the group 1 patients, but not in the group 2 patients. Conclusions: Although AV junction ablation plus pacing therapy better controlled the AF in elderly patients with medically refractory paroxysmal AF, that method was associated with a higher incidence of persistent AF and heart failure than catheter ablation of AF in the very long-term follow-up.

Original languageEnglish
Pages (from-to)457-461
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume16
Issue number5
DOIs
Publication statusPublished - May 2005

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Catheter Ablation
Atrial Fibrillation
Therapeutics
Incidence
Heart Failure
Cardiac Catheters
Group Psychotherapy
Stroke Volume
Stroke

Keywords

  • Ablation
  • Fibrillation
  • Pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation. / Hsieh, Ming Hsiung; Tai, Ching Tai; Lee, Shih Huang; Tsao, Huan Ming; Lin, Yung Kuo; Huang, Jin Long; Chan, Paul; Chen, Yi Jen; Kuo, Jen Yuan; Tuan, Ta Chuan; Hsu, Tsui Lieh; Kong, Chi Woon; Chang, Shih Lin; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 16, No. 5, 05.2005, p. 457-461.

Research output: Contribution to journalArticle

Hsieh, Ming Hsiung ; Tai, Ching Tai ; Lee, Shih Huang ; Tsao, Huan Ming ; Lin, Yung Kuo ; Huang, Jin Long ; Chan, Paul ; Chen, Yi Jen ; Kuo, Jen Yuan ; Tuan, Ta Chuan ; Hsu, Tsui Lieh ; Kong, Chi Woon ; Chang, Shih Lin ; Chen, Shih Ann. / Catheter ablation of atrial fibrillation versus atrioventricular junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2005 ; Vol. 16, No. 5. pp. 457-461.
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AU - Hsieh, Ming Hsiung

AU - Tai, Ching Tai

AU - Lee, Shih Huang

AU - Tsao, Huan Ming

AU - Lin, Yung Kuo

AU - Huang, Jin Long

AU - Chan, Paul

AU - Chen, Yi Jen

AU - Kuo, Jen Yuan

AU - Tuan, Ta Chuan

AU - Hsu, Tsui Lieh

AU - Kong, Chi Woon

AU - Chang, Shih Lin

AU - Chen, Shih Ann

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N2 - Background: Catheter ablation of atrial fibrillation (AF) has become another nonpharmacologic therapeutic option for medically refractory paroxysmal AF. Whether this method is better than atrioventricular (AV) junction ablation plus pacing therapy is unknown. The purpose of this study was to compare the very long-term (longer than 4 years) clinical outcomes of the 2 methods in elderly patients (>65 years old) with medically refractory paroxysmal AF. Methods: From January 1995 to December 2001, 71 elderly patients with medically refractory paroxysmal AF were included; group 1 included 32 patients with successful AV junction ablation plus pacing therapy and group 2, 37 patients with successful catheter ablation of AF. Results: After a mean follow-up of more than 52 months, the AF was better controlled in the group 1 patients than group 2 (100% vs 81%, P = 0.013), however, they had a significantly higher incidence of persistent AF (69% vs 8%, P <0.001) and heart failure (53% vs 24%, P = 0.001). Furthermore, the incidence of ischemic stroke and cardiac death was similar between the 2 groups. Compared with the preablation values, a significant increase in the NYHA functional class (1.7 ± 0.9 vs 1.4 ± 0.7, P = 0.01) and significant decrease in the left ventricular ejection fraction (44 ± 8% vs 51 ± 10%, P = 0.01) were noted in the group 1 patients, but not in the group 2 patients. Conclusions: Although AV junction ablation plus pacing therapy better controlled the AF in elderly patients with medically refractory paroxysmal AF, that method was associated with a higher incidence of persistent AF and heart failure than catheter ablation of AF in the very long-term follow-up.

AB - Background: Catheter ablation of atrial fibrillation (AF) has become another nonpharmacologic therapeutic option for medically refractory paroxysmal AF. Whether this method is better than atrioventricular (AV) junction ablation plus pacing therapy is unknown. The purpose of this study was to compare the very long-term (longer than 4 years) clinical outcomes of the 2 methods in elderly patients (>65 years old) with medically refractory paroxysmal AF. Methods: From January 1995 to December 2001, 71 elderly patients with medically refractory paroxysmal AF were included; group 1 included 32 patients with successful AV junction ablation plus pacing therapy and group 2, 37 patients with successful catheter ablation of AF. Results: After a mean follow-up of more than 52 months, the AF was better controlled in the group 1 patients than group 2 (100% vs 81%, P = 0.013), however, they had a significantly higher incidence of persistent AF (69% vs 8%, P <0.001) and heart failure (53% vs 24%, P = 0.001). Furthermore, the incidence of ischemic stroke and cardiac death was similar between the 2 groups. Compared with the preablation values, a significant increase in the NYHA functional class (1.7 ± 0.9 vs 1.4 ± 0.7, P = 0.01) and significant decrease in the left ventricular ejection fraction (44 ± 8% vs 51 ± 10%, P = 0.01) were noted in the group 1 patients, but not in the group 2 patients. Conclusions: Although AV junction ablation plus pacing therapy better controlled the AF in elderly patients with medically refractory paroxysmal AF, that method was associated with a higher incidence of persistent AF and heart failure than catheter ablation of AF in the very long-term follow-up.

KW - Ablation

KW - Fibrillation

KW - Pacemaker

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