Ablate and pace: Palliating the symptoms?

Atrioventricular (AV) junction ablation (producing AV block) followed by pa cemaker implantation is the most common nonpharmacologic treatment for pati ents affected by atrial fibrillation (AF) not controlled by antiarrhythmic drugs. In expert hands, the efficacy of producing complete AV block is usua lly >95% if a sequential right- and left-side approach is used; regression of AV block late after ablation (which requires a second procedure on a dif ferent day) occurs in <5% of cases. The clinical efficacy of ablate and pac e therapy in controlling arrhythmic symptoms and improving overall quality of life is well established for patients with paroxysmal AF, although not y et for patients with persistent and permanent AF, owing to the lack of suff icient clinical studies. Ablation and pacing is clinically unsuccessful in a minority Of cases. There have been little data available on Bang-term eff ects of this treatment on cardiac performance, morbidity, and survival. Alt hough concern has arisen from some case reports, no evidence of adverse eff ect has ever been shown in controlled trials, Ablation and pacing does not seem to increase thromboembolic risk. We estimate that in Europe, about 396 ,000 patients with paroxysmal AF not controlled by drug therapy could there fore be candidates for oblate and pace therapy. permanent forms of AF ore e ven more frequent, but it is unknown how many are refractory to drug therap y. The recommended pacing mode is DDDR with mode switching for paroxysmal/p ersistent AF and VVIR for permanent AF. (C) 2000 by Excerpta Medica, Inc.