Advertisement

Pulmonary vein antrum isolation, atrioventricular junction ablation, and antiarrhythmic drugs combined with direct current cardioversion: survival rates at 7 years follow-up

  • Kai Sonne
  • Dimpi Patel
  • Prasant Mohanty
  • Luciana Armaganijan
  • Lucie Riedlbauchova
  • Moataz El-Ali
  • Luigi Di Biase
  • Preeti Venkatraman
  • Mazen Shaheen
  • Marketa Kozeluhova
  • Robert Schweikert
  • J. David Burkhardt
  • Robert Canby
  • Oussama Wazni
  • Walid Saliba
  • Andrea Natale
Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Catheter ablation Atrial fibrillation (AF) Antiarrhythmic drugs (AADs) Atrioventricular junction ablation (AVJA) Direct current cardioversion (DCCV) 

References

  1. 1.
    Feinberg, W. M., Blackshear, J. L., Laupacis, A., Kronmal, R., & Hart, R. G. (1995). Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Archives of Internal Medicine, 155(5), 469–473.CrossRefPubMedGoogle Scholar
  2. 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
  3. 3.
    Kannel, W. B., Abbott, R. D., Savage, D. D., & McNamara, P. M. (1982). Epidemiologic features of chronic atrial fibrillation: the Framingham study. New England Journal of Medicine, 306(17), 1018–1022.PubMedGoogle Scholar
  4. 4.
    Benjamin, E. J., Levy, D., Vaziri, S. M., D'Agostino, R. B., Belanger, A. J., & Wolf, P. A. (1994). Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA, 271(11), 840–844.CrossRefPubMedGoogle Scholar
  5. 5.
    Di Biase, L., Fahmy, T. S., Wazni, O. M., et al. (2006). Pulmonary vein total occlusion following catheter ablation for atrial fibrillation: clinical implications after long-term follow-up. Journal of the American College of Cardiology, 48(12), 2493–2499.CrossRefPubMedGoogle Scholar
  6. 6.
    Trohman, R. G., Simmons, T. W., Moore, S. L., Firstenberg, M. S., Williams, D., & Maloney, J. D. (1992). Catheter ablation of the atrioventricular junction using radiofrequency energy and a bilateral cardiac approach. American Journal of Cardiology, 70(18), 1438–1443.CrossRefPubMedGoogle Scholar
  7. 7.
    Olgin, J. E., & Scheinman, M. M. (1993). Comparison of high energy direct current and radiofrequency catheter ablation of the atrioventricular junction. Journal of the American College of Cardiology, 21(3), 557–564.PubMedGoogle Scholar
  8. 8.
    Benjamin, E. J., Wolf, P. A., D'Agostino, R. B., Silbershatz, H., Kannel, W. B., & Levy, D. (1998). Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 98(10), 946–952.PubMedGoogle Scholar
  9. 9.
    Ozcan, C., Jahangir, A., Friedman, P. A., et al. (2001). Long-term survival after ablation of the atrioventricular node and implantation of a permanent pacemaker in patients with atrial fibrillation. New England Journal of Medicine, 344(14), 1043–1051.CrossRefPubMedGoogle Scholar
  10. 10.
    Wood, M. A., Brown-Mahoney, C., Kay, G. N., & Ellenbogen, K. A. (2000). Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation, 101(10), 1138–1144.PubMedGoogle Scholar
  11. 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. 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. 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
  14. 14.
    Wazni, O. M., Marrouche, N. F., Martin, D. O., et al. (2005). Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA, 293(21), 2634–2640.CrossRefPubMedGoogle Scholar
  15. 15.
    Miyasaka, Y., Barnes, M. E., Gersh, B. J., et al. (2006). Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. European Heart Journal, 27(8), 936–941.CrossRefPubMedGoogle Scholar
  16. 16.
    Golzari, H., Cebul, R. D., & Bahler, R. C. (1996). Atrial fibrillation: restoration and maintenance of sinus rhythm and indications for anticoagulation therapy. Annals of Internal Medicine, 125(4), 311–323.PubMedGoogle Scholar
  17. 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
  18. 18.
    Corley, S. D., Epstein, A. E., DiMarco, J. P., et al. (2004). Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation, 109(12), 1509–1513.CrossRefPubMedGoogle Scholar
  19. 19.
    Jahngir, A., Lee, V., Friedman, P. A., et al. (2007). Long-term progession and outcome with aging in patients with lone atrial fibrillation. Circulation, 115(12), 3050–3056.CrossRefGoogle Scholar
  20. 20.
    Patel, P., Keating, R., Gersh, B., et al. (2004). Outcome of patients with newly diagnosed atrial fibrillation at the mayo clinic residing in that area. American Journal of Cardiology, 94, 1379–1389.CrossRefPubMedGoogle Scholar
  21. 21.
    Friberg, L., Hammar, N., Pettersson, H., et al. (2007). Increased mortality in paroxysmal atrial fibrillation: a report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF). European Heart Journal, 28(19), 2346–2353.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kai Sonne
    • 1
  • Dimpi Patel
    • 2
  • Prasant Mohanty
    • 2
  • Luciana Armaganijan
    • 3
  • Lucie Riedlbauchova
    • 4
  • Moataz El-Ali
    • 5
  • Luigi Di Biase
    • 2
  • Preeti Venkatraman
    • 2
  • Mazen Shaheen
    • 2
  • Marketa Kozeluhova
    • 4
  • Robert Schweikert
    • 6
  • J. David Burkhardt
    • 2
  • Robert Canby
    • 2
  • Oussama Wazni
    • 6
  • Walid Saliba
    • 6
  • Andrea Natale
    • 2
  1. 1.MagdeburgGermany
  2. 2.Texas Cardiac Arrhythmia InstituteSt. David’s Medical CenterAustinUSA
  3. 3.Mc Master UniversityOntarioCanada
  4. 4.IKEMPragueCzech Republic
  5. 5.University of CairoCairoEgypt
  6. 6.Cleveland ClinicClevelandUSA

Personalised recommendations