Clinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation: A Meta-Analysis

Wood, Mark A.; Brown-Mahoney, Chris; Kay, G. Neal; Ellenbogen, Kenneth A.

doi:10.1161/01.cir.101.10.1138

Cited by 476Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Clinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation: A Meta-Analysis

Wood, Mark A., Brown-Mahoney, Chris, Kay, G. Neal, Ellenbogen, Kenneth A.·2000·Circulation

DOI 10.1161/01.cir.101.10.1138

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Abstract

BACKGROUND: Radiofrequency ablation of the atrioventricular node and permanent pacing are used for symptomatic relief in patients with medically refractory atrial fibrillation. In this study, meta-analysis was used to clarify clinical outcomes and survival after ablation and pacing therapy using data from the published literature. METHODS AND RESULTS: We used 21 studies with a total of 1181 patients in the meta-analysis. All patients had medically refractory atrial tachyarrhythmias, primarily atrial fibrillation (97%). Nineteen measures of clinical outcome, encompassing quality of life, ventricular function, exercise duration, and healthcare use, were derived from the studies. The meta-analysis demonstrated significant improvement after ablation and pacing therapy in all outcome measures except fractional shortening, which demonstrated a trend toward improvement (P=0.08). Ejection fraction did show significant improvement (P<0.001). The calculated 1-year total and sudden death mortality rates after ablation and pacing therapy were 6.3% and 2.0%, respectively. CONCLUSIONS: Ablation and pacing therapy improves a broad range of clinical outcomes for patients with medically refractory atrial fibrillation. The calculated 1-year mortality rates after this therapy are low and comparable with medical therapy.

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AV node ablation and pacing does not worsen LV function and may even improve LVEF in selected patients.
“The procedure does not worsen LV function 567 and may even improve LVEF in selected patients.[568][569][570]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [569]

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Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation
Zhuang, S., Zhang, Y., Mowrey, K. A., Li, J., Tabata, T., Wallick, D. W., Popović, Z., Grimm, R. A., Natale, A., & Mazgalev, T. N. (2002) · Circulation · doi:10.1161/01.cir.0000031802.58532.04 · Cited by 58 · see citing works

The North American experience with the Ablate and Pace Trial (APT) for medically refractory atrial fibrillation
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The North American experience with the Ablate and
Wood, M. A., & Kay, G. N. (2015)
Ablation versus medical therapy for patients with atrial fibrillation: An updated meta‐analysis
Kheshti, F., Abdollahifard, S., Hosseinpour, A., Bazrafshan, M., & Attar, A. (2023) · Clinical Cardiology · doi:10.1002/clc.24184 · Cited by 5 · see citing works
Catheter Ablation or Modulation of the AV Node
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‘Ablate and pace’ reduces mortality in heart failure patients with atrial fibrillation: an updated meta-analysis
Lewinter, C., Cleland, J. G. F., Sögütlü, E., Nielsen, T. H., Hagström, H., Køber, L., LeWinter, M., Edfors, R., Linde, C. M., & Braunschweig, F. (2026) · European Heart Journal Open · doi:10.1093/ehjopen/oeag020

Authors: Wood, M. A., Brown-Mahoney, C., Kay, G. N., & Ellenbogen, K. A.
Affiliations: University of Minnesota (US)
ORCID: Kay, G. Neal
Ellenbogen, Kenneth A.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2000-03-14
Volume: 101
Issue: 10
Pages: 1138-1144
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.101.10.1138
OpenAlex: W2069728923
Cited by: 476
References: 43
Citations by year: 2026: 12 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 19 · 2021: 16 · 2020: 7 · 2019: 5 · 2018: 11 · 2017: 9 · 2016: 15 · 2015: 6 · 2014: 15 · 2013: 18 · 2012: 26
FWCI: 4.22
Type: journal article
Language: en
Open access: closed
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
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, radiofrequency catheter ablation, atrioventricular node ablation, permanent pacemaker, mortality, sudden death, quality of life, ejection fraction, ventricular function, health care utilization
MeSH terms: Aged, Atrial Fibrillation, Cardiac Pacing, Artificial, Clinical Trials as Topic, Female, Humans, Male, Middle Aged, Survival Analysis, Treatment Outcome, Catheter Ablation

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Clinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation: A Meta-Analysis

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