Modulation of the atrioventricular node conduction to achieve rate control in patients with atrial fibrillation: Long-term results

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)442-452
Number of pages11
JournalPACE - Pacing and Clinical Electrophysiology
Volume22
Issue number3
Publication statusPublished - 1999

Fingerprint

Atrioventricular Node
Atrial Fibrillation
Exercise Tolerance
Atrioventricular Block
Sudden Cardiac Death
Heart Failure
Recurrence
Pharmaceutical Preparations

Keywords

  • Atrial fibrillation
  • Atrioventricular node conduction
  • Catheter ablation
  • Heart rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{304cec84ae774d03944baef9b1bedff9,
title = "Modulation of the atrioventricular node conduction to achieve rate control in patients with atrial fibrillation: Long-term results",
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.",
keywords = "Atrial fibrillation, Atrioventricular node conduction, Catheter ablation, Heart rate",
author = "Corrado Carbucicchio and Claudio Tondo and Gaetano Fassini and Stefania Riva and Piergiuseppe Agostoni and Claudia Galli and {Della Bella}, Paolo",
year = "1999",
language = "English",
volume = "22",
pages = "442--452",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
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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

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