Abstract
Modulation of the AV node reduces the ventricular rate during AF, without affecting AV conduction during sinus rhythm. Acute and long-term results of AV node modulation in 75 patients with AF and severe related symptoms of heart failure are presented in this study. The procedure involved, in all cases, the selective ablation of the posterior inputs to the AV node; in a subgroup of 15 patients with poor modification of AV conduction properties, a sequential approach involving subsequent anterior input ablation was performed. The procedure caused acutely a prolongation of the Wenckebach cycle length (38 patients in sinus rhythm) from 334 ± 88 to 470 ± 80 ms (P <0.01), and a reduction of the average ventricular rate (37 patients in AF) from 154 ± 31 to 88 ± 40 beats/min (P <0.01); permanent complete AV block was induced in 9 of 75 patients (12%). Considering the 'sequential' approach, an increase of the Wenckebach cycle length from 362 ± 50 to 530 ± 45 ms (P <0.01) and a reduction of the average heart rate in patients with AF from 158 ± 16 to 81 ± 20 beats/min (P <0.01) was obtained in this subgroup of patients, in whom the AH interval prolonged from 93 ± 12 to 175 ± 27 ms, and no complete AV block was observed. At a mean follow-up of 23 ± 9 months (range 2-48), the mean number of hospital admissions per patient per year decreased from 4.2 to 0.2. Five of 49 patients with paroxysmal AF and 3 of 26 patients with chronic AF had high rate recurrences (1 > 120 beats/min) that caused severe palpitations; these patients were considered as late clinical failures (8/75; 11%). All patients reported a substantial subjective improvement and an increased exercise tolerance, as documented by a semiquantitative questionnaire. There were no episodes of late AV block or sudden cardiac deaths. In conclusion, modulation of the AV node - either by slow pathway ablation, or by a 'sequential' posterior and anterior approach in refractory patients - allows a long-term control of the ventricular rate and prevents the recurrence of severe clinical symptoms in more than 75% of patients with drug refractory AF.
| Original language | English |
|---|---|
| Pages (from-to) | 442-452 |
| Number of pages | 11 |
| Journal | PACE - Pacing and Clinical Electrophysiology |
| Volume | 22 |
| Issue number | 3 |
| Publication status | Published - 1999 |
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Keywords
- Atrial fibrillation
- Atrioventricular node conduction
- Catheter ablation
- Heart rate
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Modulation of the atrioventricular node conduction to achieve rate control in patients with atrial fibrillation : Long-term results. / Carbucicchio, Corrado; Tondo, Claudio; Fassini, Gaetano; Riva, Stefania; Agostoni, Piergiuseppe; Galli, Claudia; Della Bella, Paolo.
In: PACE - Pacing and Clinical Electrophysiology, Vol. 22, No. 3, 1999, p. 442-452.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Modulation of the atrioventricular node conduction to achieve rate control in patients with atrial fibrillation
T2 - Long-term results
AU - Carbucicchio, Corrado
AU - Tondo, Claudio
AU - Fassini, Gaetano
AU - Riva, Stefania
AU - Agostoni, Piergiuseppe
AU - Galli, Claudia
AU - Della Bella, Paolo
PY - 1999
Y1 - 1999
N2 - Modulation of the AV node reduces the ventricular rate during AF, without affecting AV conduction during sinus rhythm. Acute and long-term results of AV node modulation in 75 patients with AF and severe related symptoms of heart failure are presented in this study. The procedure involved, in all cases, the selective ablation of the posterior inputs to the AV node; in a subgroup of 15 patients with poor modification of AV conduction properties, a sequential approach involving subsequent anterior input ablation was performed. The procedure caused acutely a prolongation of the Wenckebach cycle length (38 patients in sinus rhythm) from 334 ± 88 to 470 ± 80 ms (P <0.01), and a reduction of the average ventricular rate (37 patients in AF) from 154 ± 31 to 88 ± 40 beats/min (P <0.01); permanent complete AV block was induced in 9 of 75 patients (12%). Considering the 'sequential' approach, an increase of the Wenckebach cycle length from 362 ± 50 to 530 ± 45 ms (P <0.01) and a reduction of the average heart rate in patients with AF from 158 ± 16 to 81 ± 20 beats/min (P <0.01) was obtained in this subgroup of patients, in whom the AH interval prolonged from 93 ± 12 to 175 ± 27 ms, and no complete AV block was observed. At a mean follow-up of 23 ± 9 months (range 2-48), the mean number of hospital admissions per patient per year decreased from 4.2 to 0.2. Five of 49 patients with paroxysmal AF and 3 of 26 patients with chronic AF had high rate recurrences (1 > 120 beats/min) that caused severe palpitations; these patients were considered as late clinical failures (8/75; 11%). All patients reported a substantial subjective improvement and an increased exercise tolerance, as documented by a semiquantitative questionnaire. There were no episodes of late AV block or sudden cardiac deaths. In conclusion, modulation of the AV node - either by slow pathway ablation, or by a 'sequential' posterior and anterior approach in refractory patients - allows a long-term control of the ventricular rate and prevents the recurrence of severe clinical symptoms in more than 75% of patients with drug refractory AF.
AB - Modulation of the AV node reduces the ventricular rate during AF, without affecting AV conduction during sinus rhythm. Acute and long-term results of AV node modulation in 75 patients with AF and severe related symptoms of heart failure are presented in this study. The procedure involved, in all cases, the selective ablation of the posterior inputs to the AV node; in a subgroup of 15 patients with poor modification of AV conduction properties, a sequential approach involving subsequent anterior input ablation was performed. The procedure caused acutely a prolongation of the Wenckebach cycle length (38 patients in sinus rhythm) from 334 ± 88 to 470 ± 80 ms (P <0.01), and a reduction of the average ventricular rate (37 patients in AF) from 154 ± 31 to 88 ± 40 beats/min (P <0.01); permanent complete AV block was induced in 9 of 75 patients (12%). Considering the 'sequential' approach, an increase of the Wenckebach cycle length from 362 ± 50 to 530 ± 45 ms (P <0.01) and a reduction of the average heart rate in patients with AF from 158 ± 16 to 81 ± 20 beats/min (P <0.01) was obtained in this subgroup of patients, in whom the AH interval prolonged from 93 ± 12 to 175 ± 27 ms, and no complete AV block was observed. At a mean follow-up of 23 ± 9 months (range 2-48), the mean number of hospital admissions per patient per year decreased from 4.2 to 0.2. Five of 49 patients with paroxysmal AF and 3 of 26 patients with chronic AF had high rate recurrences (1 > 120 beats/min) that caused severe palpitations; these patients were considered as late clinical failures (8/75; 11%). All patients reported a substantial subjective improvement and an increased exercise tolerance, as documented by a semiquantitative questionnaire. There were no episodes of late AV block or sudden cardiac deaths. In conclusion, modulation of the AV node - either by slow pathway ablation, or by a 'sequential' posterior and anterior approach in refractory patients - allows a long-term control of the ventricular rate and prevents the recurrence of severe clinical symptoms in more than 75% of patients with drug refractory AF.
KW - Atrial fibrillation
KW - Atrioventricular node conduction
KW - Catheter ablation
KW - Heart rate
UR - http://www.scopus.com/inward/record.url?scp=0033003405&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033003405&partnerID=8YFLogxK
M3 - Article
C2 - 10192853
AN - SCOPUS:0033003405
VL - 22
SP - 442
EP - 452
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 3
ER -