PROSPECTIVE-STUDY OF LEFT-VENTRICULAR FUNCTION AFTER RADIOFREQUENCY ABLATION OF ATRIOVENTRICULAR JUNCTION IN PATIENTS WITH ATRIAL-FIBRILLATION

Background-In patients with drug resistant incessant supraventricular tachycardia, radiofrequency induced ablation of the atrioventricular j unction and pacemaker implantation have hitherto been considered a tre atment of last resort. Objective-To assess the short and long term eff ects of ablation of the atrioventricular junction on systolic and dias tolic left ventricular function in patients with atrial fibrillation w ith and without impaired left ventricular function. Patients-29 patien ts (19 men; mean age 65 (SD 7) years (range 50-76)) undergoing ablatio n of the atrioventricular junction for drug refractory atrial fibrilla tion were examined a mean of 2, 65, and 216 days after ablation of the bundle of His. Main outcome measures-left ventricular ejection fracti on and early filling deceleration times (Edec) were assessed by Dopple r echocardiography after 1 to 2 hours of ventricular pacing at a rate of 80 beats/minute. Results-In 14 patients with a left ventricular eje ction fraction < 50% left ventricular ejection fraction increased sign ificantly from 32% (11%) to 39% (11%) (65 days) and 45% (11%) (216 day s). (P < 0.001); Edec increased from 142 (46) ms to 169 (57) ms (65 da ys) and 167 (56) ms (216 days) (P < 0.05). In 15 patients with an ejec tion fraction greater than or equal to 50% at the initial examination no significant change in systolic function was observed. Conclusions-I n patients with left ventricular dysfunction long term improvement of systolic and diastolic left ventricular function was seen after ablati on of the atrioventricular junction for rate control of atrial fibrill ation. This procedure had no adverse effects on normal left ventricula r function.