RESULTS OF RADIOFREQUENCY ABLATION OF THE ATRIOVENTRICULAR JUNCTION IN PATIENTS WITH REFRACTORY ATRIAL ARRHYTHMIAS AND SEVERE LEFT-VENTRICULAR SYSTOLIC DYSFUNCTION

Results of radiofrequency ablation of the atrioventricular junction on functional capacity and left ventricular systolic function were asses sed in 8 patients (aged 68 +/- 12 years) with refractory atrial fibril lation and severe left ventricular dysfunction, the mean ejection frac tion being 31 +/- 11 % (range : 20-48 %). A clinical, echocardiographi c and angioscintigraphic follow-up was performed 24 hours (basal), 3 a nd 6 months after the procedure. During follow-up, all patients report ed the disappearance of palpitations and tiredness, a significant and early regression of effort dyspnoea from average NYHA Class 3.4 +/- 0. 7 to 2.2 +/- 0.4 (M3), (p < 0.01), a decrease in end diastolic echocar diographic dimensions (from 57 +/- 10 to 52 +/- 9 mm (M3) ; p < 0.05) resulting in an increase in fractional shortening from 26 +/- 7 % to 3 4 +/- 6 % ; p < 0.05. The isotopic EF increased from 31 +/- 11 % to 42 +/- 12 % (M3) (p < 0.01), and attained 48 +/- 12 % (M6). This study s hows that controlling the frequency and regularity of cardiac rhythm b y ablation of the atrioventricular junction in patients with refractor y AF and left ventricular dysfunction results in functional and haemod ynamic improvement, especially when there is no apparent underlying ca rdiac disease. This suggests that this method should be proposed in al l patients with refractory atrial fibrillation and left ventricular dy sfunction.