ASSESSMENT OF ATRIOVENTRICULAR JUNCTION ABLATION AND DDDR MODE-SWITCHING PACEMAKER VERSUS PHARMACOLOGICAL TREATMENT IN PATIENTS WITH SEVERELY SYMPTOMATIC PAROXYSMAL ATRIAL-FIBRILLATION - A RANDOMIZED CONTROLLED-STUDY

Background The purpose of the study was to evaluate the effect of AV j unction ablation and pacemaker implantation on quality of life and spe cific symptoms in patients with paroxysmal atrial fibrillation (AF) no t controlled by drugs. Methods and Results We performed a multicenter, randomized, 6-month evaluation of the clinical effects of AV junction ablation and DDDR mode-switching pacemaker (Abl+Pm) versus pharmacolo gical treatment in 43 patients with intolerable, recurrent paroxysmal AF of three or more episodes in the previous 6 months not controlled w ith three or more antiarrhythmic drugs. Before completion of the study , 3 patients in the drug group withdrew because of the severity of the ir symptoms and 1 patient assigned to the Abl+Pm group in whom the abl ation procedure failed. At the end of the 6 months, the 21 patients of the Abl+Pm group who completed the study showed, in comparison with t he 18 of the drug group, lower scores in the Living with Heart Failure Questionnaire (-51%, P=.0006), palpitations (-71%, P=.0000), effort d yspnea (-36%, P=.04), exercise intolerance score (-46%, P=.001), and e asy fatigue (-51%, P=.02). The scores for rest dyspnea, chest discomfo rt, and NYHA functional classification were also lower (-56%, -50%, an d -17%, respectively) in the Abl+Pm group, although not significantly. At the end of the study; palpitations were no longer present in 81% o f the Abl+Pm group and in 11% of the drug group (P=.0000). AF was docu mented in 31 of 122 visits (25%) in the Abl+Pm group and in 9 of 107 e xaminations (8%) in the drug group (P=.0005); chronic AF developed in 5 (24%) and 0 (0%) in the two groups, respectively (P=.04). Conclusion s In patients with paroxysmal AF not controlled by pharmacological the rapy, Abl+Pm treatment is highly effective and superior to drug therap y in controlling symptoms and improving quality of life. The discontin uation of drug therapy exposes patients to further recurrences of paro xysmal AF and the risk of developing permanent AF.