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Cited by 84Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Ablate and pace strategy for atrial fibrillation: long-term outcome of AIRCRAFT trial

Lim, K.-T., Davis, M. J.E., Powell, A., Arnolda, L., Moulden, K., Bulsara, M., Weerasooriya, R.·2007·Europace
DOI 10.1093/europace/eum091
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Abstract

AIMS: To determine long-term effects of atrioventricular junction ablation and pacing (AVJAP) on cardiac function and quality of life. METHODS AND RESULTS: Prospective follow-up was performed on consenting patients recruited in two participating centres representing majority of the Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT) cohort after 4-7 years. All patients underwent history, physical examination, 24 h ambulatory ECG monitoring, and transthoracic echocardiogram. Quality of life questionnaires in original AIRCRAFT trial were re-administered including CAST, assessment quality of life, and sickness impact profile. Of the 63 eligible patients, 14 refused participation, and 1 patient was lost to follow-up. The remaining 48 patients (25 males, current mean age 74 +/- 7.5 years), 23 randomized to AVJAP and 25 to pharmacologic therapy (MED) were re-evaluated. In the MED group, LVEF was 62 +/- 11% at baseline, 63 +/- 10% at 6 months, 64 +/- 9% at 12 months, and 59 +/- 12% at 5 years (P < 0.01). In the AVJAP group LVEF was 54 +/- 19% at baseline, 55 +/- 13% at 6 months, 53 +/- 15% at 12 months, and 51 +/- 17% at 5 years (P = 0.02). NYHA functional class was not statistically different between MED and AVJAP patients (1.4 vs. 1.5, P = 0.48). Death occurred in 10 MED and 5 AVJAP patients. Survival analysis incorporating all 63 patients showed no statistical difference between the 2 treatment groups (P = 0.26). The CAST quality of life questionnaire revealed that patients in the AVJAP group had fewer symptoms of irregular heart beat (P < 0.001), chest pain (P = 0.02), and difficulty breathing (P = 0.02). Psychosocial scores and overall life satisfaction were similar (P > 0.05). CONCLUSION: In this long-term follow-up of the AIRCRAFT cohort, similar decline in LVEF and NYHA class was observed in both treatment groups. AVJAP patients have better quality of life with fewer symptoms. Based on improved quality of life, ablate and pace strategy for permanent atrial fibrillation should be considered for highly symptomatic patients refractory to pharmacologic therapy.

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Crossref · 10.1093/europace/eum091

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  • AV node ablation and pacing is a relatively simple procedure with a low complication rate and low long-term mortality risk, especially when the pacemaker is implanted a few weeks before the AV nodal ablation and the initial pacing rate after ablation is set at 70-90 bpm.

    “It is a relatively simple procedure with a low complication rate and low long-term mortality risk, 563,564 especially when the pacemaker is implanted a few weeks before the AV nodal ablation and the initial pacing rate after ablation is set at 70-90 bpm.565,566”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [564]

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Authors
Lim, K.-T., Davis, M. J. E., Powell, A., Arnolda, L., Moulden, K., Bulsara, M., & Weerasooriya, R.
Affiliations
  • Royal Perth Hospital (AU)
  • The University of Western Australia (AU)
Corresponding author
Davis, M. J.E.
ORCID
Venue
Europace
Publisher
Oxford University Press (OUP)
Published
2007-05-23
Volume
9
Issue
7
Pages
498-505
ISSN
  • 1099-5129 (ISSN-L)
  • 1532-2092
DOI
10.1093/europace/eum091
OpenAlex
W2107191743
Cited by
84
References
35
Citations by year
2026: 5 · 2025: 8 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 14 · 2020: 5 · 2019: 1 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 3 · 2013: 2 · 2012: 1
FWCI
0.93
Type
journal article
Language
en
Open access
closed
Locations
  • EP Europace (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
  • Research Online (University of Wollongong) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords
atrial fibrillation, atrioventricular junction ablation, cardiac pacing, rate control, long-term outcomes, left ventricular ejection fraction, NYHA functional class, quality of life, mortality, anticoagulation, survival analysis, psychosocial outcomes, heart failure symptoms, atrial remodeling, atrial fibrillation recurrence
MeSH terms
Aged, Atrial Fibrillation, Atrioventricular Node, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pacemaker, Artificial, Prospective Studies, Quality of Life, Western Australia, Chi-Square Distribution, Survival Analysis, Treatment Outcome, Catheter Ablation

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