ASSESSMENT OF ATRIOVENTRICULAR JUNCTION ABLATION AND VVIR PACEMAKER VERSUS PHARMACOLOGICAL TREATMENT IN PATIENTS WITH HEART-FAILURE AND CHRONIC ATRIAL-FIBRILLATION - A RANDOMIZED, CONTROLLED-STUDY

Background-Uncontrolled studies have suggested that atrioventricular j unction ablation and pacemaker implantation have beneficial effects on quality of life in patients with chronic atrial fibrillation (AF). Me thods and Results-We performed a multicenter, controlled, randomized, 12-month evaluation of the clinical effects of atrioventricular juncti on ablation and VVIR pacemaker (Abl+Pm) versus pharmacological (drug) treatment in 66 patients with chronic (lasting >6 months) AF who had c linically manifest heart failure and heart rate >90 bpm on 3 standard ECGs recorded at rest during stable clinical conditions on different d ays. Before completion of the study, withdrawals occurred in 8 patient s of the drug group and in 4 patients of the Abl+Pm group. At the end of the 12 months, the 28 Abl+Pm patients who completed the study showe d lower scores in palpitations (-78%; P=0.000) and effort dyspnea (-22 %; P=0.05) than the 26 of the drug group. Lower scores, although not s ignificant, were also observed for exercise intolerance (-20%), easy f atigue (-17%), chest discomfort (-50%), Living with Heart Failure Ques tionnaire (-14%), New York Heart Association functional classification (-4%), and Activity scale (-12%). The intrapatient comparison between enrollment and month 12 showed that in the Abl+Pm group, all variable s except easy fatigue improved significantly from 14% to 82%. However, because an improvement was also observed in the drug group, the diffe rence between the 2 groups was significant only for palpitations (P=0. 000), effort dyspnea (P=0.01), exercise intolerance (P=0.005), easy fa tigue (P=0.02), and chest discomfort (P=0.02). Cardiac performance, ev aluated by means of standard echocardiogram and exercise test, did not differ significantly between the 2 groups and remained stable over ti me. Conclusions-In patients with heart failure and chronic AF, Abl+Pm treatment is effective and superior to dme therapy in controlling symp toms, although its efficacy appears to be less than that observed in u ncontrolled studies because some improvement can also be expected in m edically treated patients. Cardiac performance is not modified by the treatment.