Long-term follow-up after atrioventricular nodal ablation and pacing: Low incidence of sudden cardiac death

Sudden cardiac death (SCD) has been reported in patients with drug refracto ry AF who underwent AV nodal ablation and pacing. However, whether SCD in t hese patients is related to the underlying heart disease or to the ablating and pacing procedure remains uncertain. Between May 1987 and January 1997, AV nodal ablation was performed in 585 patients (mean age 66 +/- 11 years) with drug-resistant, paroxysmal (n = 308) or chronic (n = 277) AF in 12 It alian centers. Lone AF was present in 133 patients. After AV junction ablat ion, patients underwent VVIR (454 patients) or DDDR (131 patients) pacemake r implantation. At a fellow-up of 33.6 +/- 24.2 months, 80 (13.7%) deaths w ere recorded: 40 noncardiac, 23 nonsudden, and 17 sudden cardiac death (3%, 1.04% per year). Among five variables, including age, NYHA functional clas s, presence of heart disease, paroxysmal or chronic AF, previous embolic ev ents, and LVEF, the presence of heart disease (P = 0.007) and a LVEF < 0.45 , (P = 0.003) were associated with a higher risk of SCD. Analysis of SCD-fr ee survival by log-rank test showed a higher incidence of SCD in patients w ith LVEF ( 0.45 (P = 0.0001) and with coronary artery disease (P = 0.005). In this large cohort, a low incidence of long-term SCD after AV nodal ablat ion and pacing for drug-refractory AF was observed. The presence of underly ing heart disease and the extent of baseline LV dysfunction were associated with an increased likelihood of SCD.