Advertisement

Control of Rapid Heart Rate in Patients with Atrial Fibrillation: Drugs or Ablation?

  • M. Brignole
  • C. Menozzi
  • L. Gianfranchi
Conference paper

Abstract

Atrial fibrillation is by far the most frequent arrhythmia. It is particularly frequent in the elderly, in males, and in patients with heart disease. The prevalence of atrial fibrillation is 9.1% in men and women with cardiovascular disease (1). Data from the Framingham study (2) indicate that the overall incidence of developing atrial fibrillation was 529 new cases per year per 100 000 inhabitants aged 50–79 years (250 and 279 for paroxysmal and chronic forms, respectively). Given this high incidence, even if catheter ablation therapy were prescribed for a minority of drug-refractory patients, the total number of potential candidates for this treatment would be high. For example, during 1994 in our institutions radiofrequency catheter ablation of the atrioventricular junction and subsequent pacemaker implantation were performed in 6.4 patients per 100.000 inhabitants; that was only 1.2% of the patients with a new atrial fibrillation, but 18% of the total number of pacemakers implanted during the same period in that population. For comparison, it should be noted that the annual incidence of a new case of Wolff-Parkinson-White syndrome is 4 persons per 100 000 inhabitants (3), about one third of whom may perhaps benefit from radiofrequency therapy.

Keywords

Atrial Fibrillation Sinus Rhythm Catheter Ablation Paroxysmal Atrial Fibrillation Ventricular Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Furberg C, Psaty B, Manolio T, Gardin J, Smith V, Rautaharju P (1994) Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Heart Study). Am J Cardiol 74: 236–241PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel W, Abbott R, Savage D, McNamara P (1983) Coronary heart disease and atrial fibrillation: the Framingham study. Am Heart J 106: 389–396PubMedCrossRefGoogle Scholar
  3. 3.
    Munger T, Packer D, Hammill S, Feldman B, Bailey K, Ballard D, Holmes D, Gersh B (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation 87: 866–873PubMedGoogle Scholar
  4. 4.
    Brignole M, Menozzi C, Bottoni N, Bertulla A (1992) Comportamento della performance cardiaca nella fibrillazione atriale di diverse patogenesi. In: Rovelli F, De Vita C, Moreo A (eds) Cardiologia 1992. Librex, Milan, pp 443–451Google Scholar
  5. 5.
    Phillips E, Levine SA (1949) Auricular fibrillation without other evidence of heart disease: a cause of reversible heart failure. Am J Med 7: 479–489CrossRefGoogle Scholar
  6. 6.
    Grogan M, Smith H, Gersh B, Wood D (1992) Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 69: 1570–1573PubMedCrossRefGoogle Scholar
  7. 7.
    Lemery R, Brugada P, Cheriex E, Wellens H (1987) Reversibility of tachycardia-induced left ventricular dysfunction after closed-chest catheter ablation of the atrioventricular junction for intractable atrial fibrillation. Am J Cardiol 60: 1406–1408PubMedCrossRefGoogle Scholar
  8. 8.
    Peters KG, Kienzle MG (1988) Severe cardiomyopathy due to chronic rapidly conducted atrial fibrillation: complete recovery after restoration of sinus rhythm. Am J Med 85: 242–244PubMedCrossRefGoogle Scholar
  9. 9.
    Crijns H, Van gelder 1, Van Gilst W, Hillege H, Gosselink M, Lie K (1991) Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 68: 335–341PubMedCrossRefGoogle Scholar
  10. 10.
    Zehender M, Hohnloser S, Muller B, Meinertz T, Jost H (1992) Effects of amiodarone versus quinidine and verapamil in patients with chronic atrial fibrillation: results of a comparative study and a 2-year follow’ up. J Am Coll Cardiol 19: 1054–1059PubMedCrossRefGoogle Scholar
  11. 11.
    Hohnloser S (1994) Indications and limitations of class II and III antiarrhythmic drugs in atrial fibrillation. PACE 17: 10191025Google Scholar
  12. 12.
    Antman E, Beamer A, Cantillon C, McGowan N, Friedman P (1990) Therapy of refractory symptomatic atrial fibrillation and atrial flutter: a staged care approach with new antiarrhythmic drugs. J Am Coll Cardiol 15: 698–707PubMedCrossRefGoogle Scholar
  13. 13.
    Wong C, Lau C, Leung W, Cheng C (1990) Usefulness of labetalol in chronic atrial fibrillation. Am J Cardiol 66: 1212–1215PubMedCrossRefGoogle Scholar
  14. 14.
    Beasley R, Smith D, McHaffie D (1985) Exercise heart rates at different serum digoxin concentrations in patients with atrial fibrillation. Br Med J 290: 9–11CrossRefGoogle Scholar
  15. 15.
    Lang R, Klein H, Weiss E, David D, Sareli P, Levy A, Guerrero J, Di Segni E, Kaplinsky E (1983) Superiority of oral verapamil therapy to digoxin in treatment of chronic atrial fibrillation. Chest 83: 491–499PubMedCrossRefGoogle Scholar
  16. 16.
    Rawles J, Metcalfe M, Jennings K (1990) Time of occurrence, duration, and ventricular rate of paroxysmal atrial fibrillation: the effect of digoxin. Br Heart J 63: 225–227PubMedCrossRefGoogle Scholar
  17. 17.
    Galun E, Flugelman M, Glikson M, Eliakim M (1991) Failure of long-term digitalization to prevent rapid ventricular response in patients with paroxysmal atrial fibrillation. Chest 99: 1038–1040PubMedCrossRefGoogle Scholar
  18. 18.
    Zarowitz B, Gheorghiade M (1992) Optimal heart rate control for patients with chronic atrial fibrillation: are pharmacologic choices truly changing ? Am Heart J 123: 1401–1403PubMedCrossRefGoogle Scholar
  19. 19.
    Zoble R, Brewington J, Olukotun A, Gore R (1987) Comparative effects of nadolol-digoxin combination therapy and digoxin monotherapy for chronic atrial fibrillation. Am J Cardiol 60: 39D - 45DPubMedCrossRefGoogle Scholar
  20. 20.
    Roberts S, Diaz C, Nolan P, Salerno D, Stapczynski S, Zbrozek A, Ritz E, Bauman J, Vlasses P (1993) Effectiveness and costs of digoxin treatment for atrial fibrillation and flutter. Am J Cardiol 72: 567–573PubMedCrossRefGoogle Scholar
  21. 21.
    Roth A, Harrison E, Mitani G, Cohen J, Rahimtoola S, Elkayam U (1986) Efficacy and safety of medium-and high-dose diltiazem alone and in combination with digoxin for control of heart rate at rest and during exercise in patients with chronic atrial fibrillation. Circulation 73: 316–324PubMedCrossRefGoogle Scholar
  22. 22.
    Lewis R, Lakhani M, Moreland A, McDevitt D (1987) A comparison of verapamil and digoxin in the treatment of atrial fibrillation. Eur Heart J 8: 148–153PubMedGoogle Scholar
  23. 23.
    Lewis R, Laing E, Moreland T, Service E, McDevitt D (1988) A comparison of digoxin, diltiazem and their combination in the treatment of atrial fibrillation. Eur Heart J 9: 279–283PubMedGoogle Scholar
  24. 24.
    Lang R, Klein H, Di Segni E, Gefen J, Sareli P, Libhaber C, David D, Weiss E, Guerrero J, Kaplinsky E (1983) Verapamil improves exercise capacity in chronic atrial fibrillation: double-blind crossover study. Am Heart J 105: 820–824PubMedCrossRefGoogle Scholar
  25. 25.
    Panidis I, Monganroth J, Baessler C (1983) Effectiveness and safety of oral verapamil to control exercise-induced tachycardia in patients with atrial fibrillation receiving digitalis. Am J Cardiol 52: 1197–1201PubMedCrossRefGoogle Scholar
  26. 26.
    Schwartz J, Keefe D, Kates D, Kirsten E, Harrison D (1982) Acute and chronic pharmacodynamic interaction of verapamil and digoxin in atrial fibrillation. Circulation 65: 1163–1170PubMedCrossRefGoogle Scholar
  27. 27.
    Steinberg J, Katz R, Bren G, Buff L, Varghese J (1987) Efficacy of oral diltiazem to control ventricular response in chronic atrial fibrillation at rest and during exercise. J Am Coll Cardiol 9: 405–411PubMedCrossRefGoogle Scholar
  28. 28.
    Maragno E, Santostasi G, Gaion R, Trento M, Grion A, Mi-raglia G, Dalla Volta S (1988) Low-and medium-dose diltiazem in chronic atrial fibrillation: comparison with digoxin and correlation with drug plasma levels. Am Heart J 116: 385–392PubMedCrossRefGoogle Scholar
  29. 29.
    Lundstrom T, Ryden L (1990) Ventricular rate control and exercise performance in chronic atrial fibrillation: effects of diltiazem and verapamil. J Am Coll Cardiol 16: 86–90PubMedCrossRefGoogle Scholar
  30. 30.
    Atwood E, Myers J, Sullivan M, Forbes S, Pewen W, Froelicher V (1988) Diltiazem and exercise performance in patients with chronic atrial fibrillation. Chest 92: 20–25CrossRefGoogle Scholar
  31. 31.
    DiBianco R, Monganroth J, Freitag J, Ronan J, Lindgren K, Donohue D, Larca L, Chadda K, Olukotun A (1984) Effects of nadolol on the spontaneous and exercise-provoked heart rate of patients with chronic atrial fibrillation receiving stable dosages of digoxin. Am Heart J 108: 1121–1127PubMedCrossRefGoogle Scholar
  32. 32.
    Atwood E, Sullivan M, Forbes S, Myers J, Pewen W, Olson H, Froelicher V (1987) Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation. J Am Coll Cardiol 10: 314–320PubMedCrossRefGoogle Scholar
  33. 33.
    Brodsky M, Saini R, Bellinger R, Zoble R, Weiss R, Powers L (1994) Comparative effects of the combination of digoxin and dl-sotalol therapy versus digoxin monotherapy for control of ventricular response in chronic atrial fibrillation. Am Heart J 127: 572–577PubMedCrossRefGoogle Scholar
  34. 34.
    Channer K, Papouchado M, James M, Pitcher D, Russell Rees J (1987) Towards improved control of atrial fibrillation. Eur Heart J 8: 141–147PubMedGoogle Scholar
  35. 35.
    Packer DL, Bardy GH, Worley SJ, Smith MS, Cabb FR, Coleman E, Gallagher JJ, German LD (1986) Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 57: 563–570PubMedCrossRefGoogle Scholar
  36. 36.
    Raeder E, Podrid P, Lown B (1985) Side effects and complications of amiodarone therapy. Am Heart J 109: 975–983PubMedCrossRefGoogle Scholar
  37. 37.
    Souza O, Gursoy S, Simonis F, Steurer G, Andries E, Brugada P (1992) Right-sided versus left-sided radiofrequency ablation of the His bundle. PACE 15: 1454–1459PubMedCrossRefGoogle Scholar
  38. 38.
    Trohman R, Simmons T, Moore S, Firstenberg M, Williams D, Maloney J (1992) Catheter ablation of the atrioventricular junction using radiofrequency energy and a bilateral cardiac approach. Am J Cardiol 70: 1438–1443PubMedCrossRefGoogle Scholar
  39. 39.
    Twidale N, Sutton K, Bartlett L, Dooley A, Winstanley S, Heddle W, Hassam R, Koutsounis H (1993) Effects on cardiac performance of atrioventricular node catheter ablation using radiofrequency current for drug-refractory atrial arrhythmias. PACE 16: 1275–1284PubMedCrossRefGoogle Scholar
  40. 40.
    Heinz G, Siostrzonek P, Kreiner G, Gossinger H (1992) Improvement in left ventricular systolic function after successful radiofrequency His bundle ablation for drug-refractory, chronic atrial fibrillation and recurrent atrial flutter. Am J Cardiol 69: 489–492PubMedCrossRefGoogle Scholar
  41. 41.
    Kalbfleisch S, Williamson B, Man C, Volperian V, Hummel J, Calkins H, Strickberger A, Langberg J, Morady F (1993) A randomized comparison of the right-and left-sided approaches to ablation of the atrioventricular junction. Am J Cardiol 72: 1406–1410PubMedCrossRefGoogle Scholar
  42. 42.
    Menozzi C, Brignole M, Gianfranchi L, Lolli G, Oddone D, Gaggioli G, Bottoni N (1994) Radiofrequency catheter ablation and modulation of atrioventricular conduction in patients with atrial fibrillation. PACE 17: 2143–2149PubMedCrossRefGoogle Scholar
  43. 43.
    Kay N, Epstein A, Dailey S, Plumb V (1993) Role of radiofrequency ablation in the management of supraventricular arrhythmias: experience in 760 consecutive patients. J Cardiovasc Electrophysiol 4: 371–389PubMedCrossRefGoogle Scholar
  44. 44.
    Brignole M, Gianfranchi L, Menozzi C, Bottoni N, Bollini R, Lolli G, Oddone D, Gaggioli G (1994) Influence of atrio-ventricular junction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol 74: 242–246PubMedCrossRefGoogle Scholar
  45. 45.
    Rosenquist M, Lee M, Moulinier L, Springer M, Abbott J, Wu J, Langberg J, Griffin J, Scheinman M (1990) Long-term follow-up of patients after transcatheter direct current ablation of the atrioventricular junction. J Am Coll Cardiol 16: 1467–1474CrossRefGoogle Scholar
  46. 46.
    Kay N, Bubien R, Epstein A, Plumb V (1988) Effect of catheter ablation of the atrioventricular junction on quality of life and exercise tolerance in paroxysmal atrial fibrillation. Am J Cardiol 62: 741–744PubMedCrossRefGoogle Scholar
  47. 47.
    Rodriguez LM, Smeets J, Xie B, de Chillou C, Cheriex E, Pieters F, metzger J, den Dulk K, Wellens H (1993) Improvement in left ventricular function by ablation of atrioventricular nodal conduction in selected patients with lone atrial fibrillation. Am J Cardiol 72: 1137–1141Google Scholar
  48. 48.
    Hindricks G (1993) The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J 14: 1644–1653PubMedCrossRefGoogle Scholar
  49. 49.
    Scheinman M (1994) Patterns of catheter ablation practice in the United States: results of the 1992 NASPE survey. PACE 17: 873–875PubMedCrossRefGoogle Scholar
  50. 50.
    Raviele A, Delise P, Themistoclakis S, Coluccia S (1994) Complicanze dell’ablazione transcatetere. G Ital Cardini 24: 132–147Google Scholar
  51. 51.
    Olgin J, Scheinman M (1995) Catheter ablation of the atrioventricular node for treatment of supraventricular tachyarrhythmias. In: Zipes D and Jalife J (eds) Cardiac electrophysiology. From cell to bedside. Saunders, Philadelphia, pp 1453–1460Google Scholar
  52. 52.
    Evans T, Scheinman M, Zipes D, Benditt D, Breithardt G, Camm J, El-Sherif N, Fisher J, Fontaine G, Levy S, Pristosky E, Josephson M, Morady F, Ruskin J (1988) The percutaneous cardiac mapping and ablation registry: final summary of results. PACE 11: 1621–1626PubMedCrossRefGoogle Scholar
  53. 53.
    Evans T (1991) Predictors of in-hospital mortality after DC catheter ablation of atrioventricular junction. Results of a prospective, international, multicenter study. Circulation 84: 1924–1937PubMedGoogle Scholar
  54. 54.
    O1gin J, Scheinman M (1993) Comparison of high energy direct current and radiofrequency catheter ablation of the atrioventricular junction. J Am Coll Cardiol 21: 557–564PubMedCrossRefGoogle Scholar
  55. 55.
    Levy S, Bru P, Aliot E, Attuel P, Barnay C, Clementy J, Ebagosti A, Fauchier JP, Fontaine G, Leclercq JF (1988) Longterm follow-up of atrioventricular junctional transcatheter electrical ablation. PACE 11: 1149–1153PubMedCrossRefGoogle Scholar
  56. 56.
    Sadoul N, de Chillou C, Lamouri F, Simon JP, Reeb T, Pescariou S, Dodinot B, Aliot E (1994) Results, complications and long-term outcome of percutaneous ablation of atrioventricular conduction: a series of 85 cases. Arch Mal Coeur 87: 1453–1458Google Scholar
  57. 57.
    Carson P, Jonhson G, Dunkman B, Fletcher R, Farrell L, Cohn J (1993) The influence of atrial fibrillation on prognosis in mild to moderate heart failure. The V-HeFT studies. Circulation 87: VI102–VI110Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • M. Brignole
    • 1
  • C. Menozzi
    • 2
  • L. Gianfranchi
    • 1
  1. 1.Ospedali RiunitiSezione di AritmologiaLavagna, GenoaItaly
  2. 2.Ospedale S. Maria NuovaSezione di AritmologiaReggio EmiliaItaly

Personalised recommendations