Pulmonary vein antrum isolation, atrioventricular junction ablation, and antiarrhythmic drugs combined with direct current cardioversion: survival rates at 7 years follow-up
To report survival rates in patients treated with pulmonary vein antrum isolation (PVAI), atrioventricular junctional ablation (AVJA), and antiarrhythmic and direct current cardioversion (A + DCCV) at 7 years follow-up.
From February 2002–December 2004, 1,000 consecutive patients underwent PVAI or A + DCCV or AVJA. These patients were matched in a nested case-controlled methodology. Survival rates were compared at the end of 7 years.
Three hundred and forty-five consecutive patients had undergone PVAI (34.5%), 157 (15.7%) consecutive patients AVJA, and 498(49.8%) A + DCCV. After matching the patients in a nested case-controlled methodology, 146 (32.3%) patients were in the PVAI group, 205 (59.4%) in the A + DCCV, and 101 (22.3%) in the AVJA.
At 69 ± 27 months, 63 (13.9%) patients had died in the matched population. Three (2.1%) patients died in the PVAI group, 34 (16.5%) in the A + DCCV group, and 26 (25.7%) in the AVJA group. In multivariable analysis, treatment strategy was a significant predictor of mortality. Compared to patients with PVAI (reference group), those with A + DCCV (HR 4.9, p = 0.011) and AVJA (HR 10.6, p = 0.001) procedures had higher mortality risk.
Compared to the other two procedures, patients with PVAI had the best survival rates at the end of 7 years. However, the observational case-control design of this study incurs the potential for confounding due to non-randomized treatment selection, and creates a major limitation in making valid generalization of the findings.
KeywordsCatheter ablation Atrial fibrillation (AF) Antiarrhythmic drugs (AADs) Atrioventricular junction ablation (AVJA) Direct current cardioversion (DCCV)
- 2.Go, A. S., Hylek, E. M., Phillips, K. A., et al. (2001). Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA, 285(18), 2370–2375.CrossRefPubMedGoogle Scholar
- 11.Flaker, G. C., Blackshear, J. L., McBride, R., Kronmal, R. A., Halperin, J. L., & Hart, R. G. (1992). Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. Journal of the American College of Cardiology, 20(3), 527–532.PubMedCrossRefGoogle Scholar
- 12.Pappone, C., Rosanio, S., Augello, G., et al. (2003). Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. Journal of the American College of Cardiology, 42(2), 185–197.CrossRefPubMedGoogle Scholar
- 13.Hsieh, M.-H., Tai, C.-T., Lee, S.-H., et al. (2005). Catheter ablation of atrial fibrillation vs. atriaoventriuclar junction ablation plus pacing therapy for elderly patients with medically refractory paroxysmal atrial fibrillation. JCE, 16, 457–461.Google Scholar
- 17.Fuster, V., Ryden, L. E., Cannom, D. S., et al. (2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Journal of the American College of Cardiology, 48(4), 854–906.CrossRefPubMedGoogle Scholar