Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation
Open accessAbstract
OBJECTIVE: To assess long term mortality and identify factors associated with the development of permanent atrial fibrillation after atrioventricular (AV) node ablation for drug refractory paroxysmal atrial fibrillation. DESIGN: Retrospective cohort study. SETTING: UK tertiary centre teaching hospital. PATIENTS: Patients admitted to the University Hospital Birmingham between January 1995 and December 2000. INTERVENTIONS: AV node ablation and dual chamber mode switching pacing. MAIN OUTCOME MEASURES: Long term mortality and predictors of permanent atrial fibrillation, assessed through Kaplan-Meier curves and logistic regression. RESULTS: 114 patients (1995-2000) were included: age (mean (SD)), 65 (9) years; 55 (48%) male; left atrial diameter 4 (1) cm; left ventricular end diastolic diameter 5 (1) cm; ejection fraction 54 (17)%. Indications for AV node ablation were paroxysmal atrial fibrillation in 95 (83%) and paroxysmal atrial fibrillation/flutter in 19 (17%). The survival curve showed a low overall mortality after 72 months (10.5%). Fifty two per cent of patients progressed to permanent atrial fibrillation within 72 months. There was no difference in progression to permanency between paroxysmal atrial fibrillation and paroxysmal atrial fibrillation/flutter (log rank 0.06, p = 0.8). Logistic regression did not show any association between the variables collected and the development of permanent atrial fibrillation, although age over 80 years showed a trend (p = 0.07). CONCLUSIONS: Ablate and pace is associated with a low overall mortality. No predictors of permanent atrial fibrillation were identified, but 48% of patients were still in sinus rhythm at 72 months. These results support the use of dual chamber pacing for paroxysmal atrial fibrillation patients after ablate and pace.
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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 [563]
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- Authors
- Queiroga, A., Marshall, H. J., Clune, M., & Gammage, M. D.
- Affiliations
- University of Birmingham (GB)
- Queen Elizabeth Hospital Birmingham (GB)
- Corresponding author
- Gammage, M D
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2003-08-15
- Volume
- 89
- Issue
- 9
- Pages
- 1035-1038
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- PMC
- PMC1767849
- OpenAlex
- W2156314246
- Cited by
- 36
- References
- 20
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 2 · 2021: 4 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (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
- atrioventricular node ablation, permanent atrial fibrillation, paroxysmal atrial fibrillation, paroxysmal atrial flutter, DDD pacing, long-term mortality, sinus rhythm maintenance
- MeSH terms
- Aged, Atrial Fibrillation, Epidemiologic Methods, Female, Humans, Male, Recurrence, Catheter Ablation, Disease Progression
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