Clinical and echocardiographic long term follow-up after ablation of the AV junction: Comparison between paroxysmal and chronic atrial tachyarrhythmias

M. Gasparini, M. Lunati, G. Magenta, G. Cattafi, G. Maccabelli, A. Alberti, G. R. Ciliberto, G. Gadaleta

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Abstract

From July 87 to July 93, 99 pts (62 female and 37 male) (mean age 57 ± 11 yrs) have undergone AVJ ablation for drug refractory (5.2 ineffective drugs/pt) A.T. (Af, AFl, automatic atrial tachycardia). Organic heart disease was present in 60 pts. 60 pts suffered multiple recurrences of paroxysmal A.T. (Group A), 39 presented a chronic form of A.T. (Group B). Until 1991 DC shock energy was used (53 pts), since 1992 RF energy has been employed (39 pts), in 7 cases DC shock was successfully utilised after ineffective RF ablation. Every pt was prospectively followed up for a mean of 29.5 (3-76) months with clinical and PM evaluation every 6 months and received complete echocardiographic evaluation before AVJ ablation, at 3 months after ablation and at the end of the follow up. At the last clinical control every pt received a questionnaire with a graphic semi quantitative subjective evaluation of palpitation, subjective work capacity and sense of general well being after AVJ ablation. Results: Stable complete AV block was obtained in 97 pts (97%) acutely, and in 96% on long term follow up. Group A: At the end of the follow up there was a significant improvement of the NYHA class (1.5 ± 0.6 vs 2.5 ± 0.9 p <0. 0001), and a clear improvement of subjective parameters evaluated by the questionnaire (7.8 ± 0.4 for palpitation, 6.9 ± 0.9 for work capacity and 7.1 ± 1 for the sense of general well being, all significant p <0.0001). The echo parameters remained substantially unmodified from pre ablation to 3 months and to the end of the follow up except for a slight but signifiicant increase of diastolic (49.3 ± 6.8 basal vs 52.5 ± 5.2 end of f.u. p <0.02) and systolic diameter (33.9 ± 8.8 basal vs 37.1 ± 6.1 end of f.u. p <0.03). Group B: At the end of the follow up there was a significant improvement of the NYHA class (1.6 ± 0.6 vs 2.8 ± 0.9 p <0.0001) and also a clear improvement of subjective parameters evaluated by the questionnaire (7.8 ± 0.4 for palpitation, 6.9 ± 0.7 for work capacity and 7.1 ± 0.9 for the sense of general well being all significant p <0.0001). For what concerns the echocardiographic evaluation it was possible to observe trend to an amelioration of any parameter from pre ablation to 3 months and to the end of the f.u.. A significant increase of circumferential shortening was reached (27.4% ± 9.1 basal vs 31.8 ± 8.7 at 3 months p <0.02) and a significant reduction was observed for systolic diameter (38.8 ± 11.4 basal vs 36.2 ± 9.4 at 3 months p <0.05) and for diastolic (118.9 ± 48 basal vs 112.3 ± 38.1 at 3 months p <0.02) and systolic volumes (65.3 ± 37.5 basal vs 57.1 ± 30.7 at 3 months p <0.001), while EF increased from 47 ± 12% to 50 ± 11%. Conclusions: Ablation of AVJ seems to be a safe and useful therapeutic approach in all pts suffering for drug resistant A.T., at least judging from the improvement of the NYHA class and for what pts report from the subjective point of view. The best objective (and namely echocardiographic) results should be expected in chronic forms of A.T. in which the atrial contribution is already lost and we can expect an amelioration of the global performance of the heart after AVJ ablation.

Original languageEnglish
Pages (from-to)877-881
Number of pages5
JournalNew Trends in Arrhythmias
Volume9
Issue number4
Publication statusPublished - 1993

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Keywords

  • AV junction ablation
  • chronic atrial tachyarrhythmias
  • long term follow up
  • paroxysmal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Gasparini, M., Lunati, M., Magenta, G., Cattafi, G., Maccabelli, G., Alberti, A., Ciliberto, G. R., & Gadaleta, G. (1993). Clinical and echocardiographic long term follow-up after ablation of the AV junction: Comparison between paroxysmal and chronic atrial tachyarrhythmias. New Trends in Arrhythmias, 9(4), 877-881.