Ablate and pace for drug refractory paroxysmal atrial fibrillation - Is ablation necessary?

Background: Atrio-ventricular junctional ablation with pacemaker insertion has been shown to improve quality of life in patients with drug refractory paroxysmal atrial fibrillation. It is unknown whether this improvement is s econdary to the ablation procedure or to the pacemaker mode utilised. To in vestigate this we reviewed our experience of implanting a dual chamber rate responsive pacemaker with mode switching (DDDR/MS) alone on quality of lif e in this patient group. Methods and results: Over a 1-year period, 19 pati ents (mean age 62 +/- 9 years, 13 female) with drug refractory paroxysmal a trial fibrillation (mean duration of symptoms 8.7 +/- 7 years, failed 3.1 /- 0.9 anti-arrhythmic drugs, amiodarone in 15) were recruited. Quality of life was assessed at baseline and after 1 month using a cardiac specific qu estionnaire, the modified Karolinska questionnaire. The mean score for all patients significantly improved by 39% at follow up (baseline 59 +/- 24, 1 month 36 +/- 24, P = 0.001). Individually 15 patients (79%) had an improvem ent in their score, whilst for 13 patients (68%) their symptoms were suffic iently improved after pacing that ablation was not required. The benefit wa s maintained to a mean follow up of 12 +/- 5 months (score 31 +/- 20, P < 0 .001). Six patients remained symptomatic after pacing and requested further treatment. Benefit was unrelated to symptoms at baseline or the number and total duration of paroxysmal atrial fibrillation episodes recorded on pace maker Holler. Conclusions: Patients with drug refractory paroxysmal atrial fibrillation, DDDR/MS pacing alone can improve quality of life without conc urrent atrio-ventricular junctional ablation in a significant proportion of patients. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.