Survival of DDD pacing mode after atrioventricular junction ablation and pacing for refractory atrial fibrillation

Background Patients with recurrent forms of atrial fibrillation may receive dual-chamber pacemakers after atrioventricular junction ablation for refra ctory symptoms. These patients are at risk for chronic atrial Fibrillation, which would negate the benefits of dual-chamber pacing. The purpose of thi s study was to examine the survival of dual-chamber pacing modes in patient s undergoing ablate and pace therapy. Methods and Results one hundred fifty-six patients underwent ablate and pac e therapy for medically refractory chronic (70 patients) or recurrent (86 p atients) atrial fibrillation. Seventy-eight percent of patients had structu ral heart disease. The mean age was 66 +/- 11 years, with an average ejecti on fraction of 48% +/- 18%. The choice of pacing mode and programming were at the discretion of the investigators. At implantation, 91 patients (58%) were programmed to WI mode, 47 (30%) were programmed to DDD mode, and 18 (1 2%) were programmed to DDI mode. After 1 year of follow-vp, 10 DDD patients were reprogrammed to WI mode (7 patients) or DDI mode (3 patients), most f requently for chronic atrial fibrillation (7 patients). Two patients with D DI mode were reprogrammed to WI and DDD modes (1 patient each). Survival of the DDD mode was 76% at 1 year by Kaplan-Meier analysis. Reprogramming fro m DDD mode was not associated with patient age, left ventricular ejection f raction, discontinuation of antiarrhythmic drugs, or the duration of atrial fibrillation symptoms before ablation. Conclusions Seventy-six percent of patients with recurrent atrial fibrillat ion who are initially programmed to DDD mode remain in DDD mode 1 year afte r ablation and pacing therapy. The modest rate of progression to chronic at rial fibrillation supports the use of dual-chamber pacing in this setting.