Atrioventricular Nodal Ablation in Atrial Fibrillation: A Meta-Analysis and Systematic Review

Chatterjee, Neal A.; Upadhyay, Gaurav A.; Ellenbogen, Kenneth A.; McAlister, Finlay A.; Choudhry, Niteesh K.; Singh, Jagmeet P.

doi:10.1161/circep.111.967810

Cited by 109Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Atrioventricular Nodal Ablation in Atrial Fibrillation: A Meta-Analysis and Systematic Review

Chatterjee, Neal A., Upadhyay, Gaurav A., Ellenbogen, Kenneth A., McAlister, Finlay A., Choudhry, Niteesh K., Singh, Jagmeet P.·2012·Circulation Arrhythmia and Electrophysiology

DOI 10.1161/circep.111.967810

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Abstract

BACKGROUND: In the treatment of patients with refractory atrial fibrillation (AF), the safety and efficacy of atrioventricular nodal ablation (AVNA) versus pharmacotherapy alone remains unclear. Additionally, the impact of AVNA in patients with reduced systolic function is of growing interest. METHODS AND RESULTS: A total of 5 randomized or prospective trials were included for efficacy review (314 patients), 11 studies for effectiveness review (810 patients), and 47 studies for safety review (5632 patients). All-cause mortality was similar between AVNA and medical therapy (3.1% versus 3.3%; relative risk ratio, 1.05; 95% confidence interval [CI], 0.29-3.85). There was no significant difference in exercise duration or ejection fraction (EF) with AVNA relative to pharmacotherapy. In subgroup analysis, patients with baseline systolic dysfunction (116 patients; mean EF, 44%) showed significant relative improvement in EF after AVNA (+4% greater; 95% CI, 3.11-4.89). In pooled observational analysis, AVNA was also associated with significant improvement in EF only in patients with systolic dysfunction (+7.44%; 95% CI, 5.4-9.5). The incidence of procedure-related mortality (0.27%) and malignant arrhythmia (0.57%) was low. At mean follow-up of 26.5 months, the incidence of sudden cardiac death after AVNA was 2.1%. There was significant heterogeneity in quality-of-life scales used; compared with pharmacotherapy, AVNA was associated with significant improvement in several symptoms (palpitations, dyspnea). CONCLUSIONS: In the management of refractory AF, AVNA is associated with improvement in symptoms and quality of life, with a low incidence of procedure morbidity. In patients with reduced systolic function, AVNA demonstrates small but significantly improved echocardiographic outcomes relative to medical therapy alone.

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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 [567]

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Authors: Chatterjee, N. A., Upadhyay, G. A., Ellenbogen, K. A., McAlister, F. A., Choudhry, N. K., & Singh, J. P.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Chatterjee, Neal A.
Upadhyay, Gaurav A.
Ellenbogen, Kenneth A.
McAlister, Finlay A.
Choudhry, Niteesh K.
Singh, Jagmeet P.
Venue: Circulation Arrhythmia and Electrophysiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-02
Volume: 5
Issue: 1
Pages: 68-76
ISSN: 1941-3084 (ISSN-L)
1941-3149
DOI: 10.1161/circep.111.967810
OpenAlex: W2084871846
Cited by: 109
References: 77
Citations by year: 2026: 6 · 2025: 9 · 2024: 10 · 2023: 6 · 2022: 15 · 2021: 11 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 6 · 2016: 6 · 2015: 5 · 2014: 7 · 2013: 4 · 2012: 3
FWCI: 3.07
Type: journal article
Language: en
Open access: closed
Locations: Circulation Arrhythmia and Electrophysiology (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: atrioventricular node ablation, refractory atrial fibrillation, pharmacotherapy, reduced systolic function, ejection fraction, all-cause mortality, sudden cardiac death, procedure-related mortality, quality of life, exercise duration, malignant arrhythmias
MeSH terms: Atrial Fibrillation, Atrioventricular Node, Clinical Trials as Topic, Humans, Catheter Ablation

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Atrioventricular Nodal Ablation in Atrial Fibrillation: A Meta-Analysis and Systematic Review

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