COMPARISONS OF QUALITY-OF-LIFE AND CARDIAC-PERFORMANCE AFTER COMPLETEATRIOVENTRICULAR JUNCTION ABLATION AND ATRIOVENTRICULAR JUNCTION MODIFICATION IN PATIENTS WITH MEDICALLY REFRACTORY ATRIAL-FIBRILLATION

Objectives. This study compared the long-term effects of complete atri oventricular junction (AVJ) ablation with those of AVJ modification in patients with medically refractory atrial fibrillation (AF). Backgrou nd. Comparisons between the long term effects of AVJ ablation with tho se of AVJ modification in patients with medically refractory AF have n ot been systematically studied. Methods. Sixty patients with medically refractory AF were randomly assigned to receive complete AVJ ablation with permanent pacing or AVJ modification. Subjective perception of q uality of life (QOL) was assessed by a semiquantitative questionnaire before and 1 and 6 months after ablation. Cardiac performance was eval uated by echocardiography and radionuclide angiography within 24 h (ba seline) and at 1 and 6 months after ablation. Results. Both methods we re associated with significant improvement in general QOL and a signif icant reduction in the frequency of major symptoms and symptoms during attacks. The frequency of hospital admission and emergency room visit s and antiarrhythmic drug trials significantly decreased after ablatio n in both groups. However, patients after complete AVJ ablation had a significantly greater improvement in general QOL and a significantly r educed frequency of major symptoms and symptoms during attacks (includ ing palpitation, dizziness, chest oppression, blurred vision and synco pe). Left ventricular (LV) systolic function and the ability to perfor m activities of daily life significantly improved after ablation in pa tients with depressed LV function in both groups. All improvements aft er ablation or modification were maintained over the 6-month follow-up period. Conclusions. AVJ ablation with permanent pacing, as compared with AVJ modification, had a significantly greater ability to decrease the frequency of attacks and the extent of symptoms of AF, and the pa tients who received this procedure were more satisfied with their gene ral well-being. (C) 1998 by the American College of Cardiology.