Radiofrequency ablation of atrioventricular junction and pacemaker implantation versus modulation of atrioventricular conduction in drug refractory atrial fibrillation

Modulation of atrioventricular (AV) node conduction and radiofrequency abla tion of AV junction are alternative approaches to control ventricular rate in drug refractory atrial fibrillatian (AF). In 2 centers, 120 patients wer e treated either with AV junction ablation (center 1, group 1, 60 patients [30 men, aged 64 +/- 11 years], paroxysmal AF in 24 patients) or with modul ation (group 2, 60 patients [32 men, aged 58 +/- 12 years], paroxysmal AF i n 43 patients). In group 1, complete AV block was achieved in all patients. In group 2, the procedure was performed in sinus rhythm (30 patients), pro longing the Wenckebach cycle length from 328 +/- 85 to 456 +/- 80 ms (p <0. 01) or during AF (30 patients), decreasing ventricular rate from 178 +/- 35 to 96 +/- 35 beats/min (p <0.01), and to <100 beats/min in 17 patients (61 %). Complete AV block was induced in 9 of 60 patients (15%). In groups 1 an d 2, at a follow-up of 27 +/- 7 and 26 +/- 6 months, there were 2 deaths (1 cardiac, 1 sudden death) and 1 death for end-stage heart failure, respecti vely. Hospital readmissions decreased from 3.2 to 0.2 and from 4.2 to 0.2/y ear; late AF recurrences at of >120 beats/min were documented in 6% and 12% , respectively. Symptom score analysis including effort and rest dyspnea, e xercise intolerance, weakness, and palpitation showed a significant improve ment in both treatment groups, when acutely effective, in patients with par oxysmal and/or chronic AF. In conclusion, ablation of the AV junction shows a higher acute success rate compared with modulation of the AV node conduc tion in patients with drug refractory AF. Depending on the acute success, b oth approaches therefore were similarly effective in achieving long-term ve ntricular rate control and symptom score improvement. (C) 1999 by Excerpta Medica, Inc.