RT-145
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Dual chamber pacemaker in
patients with
atrial fibrillation submitted for ablation of the atrio-ventricular junction
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Diran Igidbashian*, Patrizio
Mazzone, Mariano Rillo, Maria Luisa Loricchio, Carlo Pappone.
Department of Cardiology, S. Raffaele Hospital, Milan,
*Department of Cardiology, Civil Hospital, Legnago, Italy
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Abstract
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A randomised, crossover, pilot study was conducted to
evaluate the effects of DDD versus DDDR pacing modes in 30 patients referred for
radiofrequency (RF) ablation of the atrio-ventricular junction and permanent dual chamber
stimulation as a treatment of hemodynamically ill-tolerated, rapid ventricular response,
drug-resistant, paroxysmal atrial fibrillation. After RF ablation and pacemaker (PM)
implantation, the patients were randomised into groups A and B. All the PMs were
programmed, with the automatic mode-switch (AMS) activated, first for a run-in period of
eight weeks in the VDD mode and subsequently group A in the DDDR mode and group B in the
DDD mode for eight weeks, followed by DDDR/DDD crossover and viceversa for other eight
weeks. Data regarding symptom frequency and intensity, quality of life (QOL) and AMS
activations were collected at the pre- and post-implantation follow-ups. Twelve patients
were withdrawn from the study because of chronic atrial fibrillation or logistic problems.
The data appear to show a net reduction of both the symptomatic episodes and of their
intensity, respect to the pre-procedure period, in all the three stimulation modes with a
further decrease in the DDDR and DDD modes respect to the VDD mode. Also the QOL scores
adopted increased respect to the pre-procedure period. Both symptoms/day and the AMS
activations/day ratios appeared to be slightly superior in the group A patients,
regardless of the mode of dual chamber stimulation and seem more patient than stimulation
mode related. Therefore the rate responsive feature does not seem to add any further
benefit, particularly regarding atrial fibrillation prevention, respect to the standard
dual chamber stimulation mode. The study appears to be conditioned by the relatively small
number of eligible patients, which warrants its prosecution, extending it to more centres.
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Key Words
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Atrial fibrillation – RF catheter ablation
of AV junction
dual chamber pacemaker, pacing mode (DDD, DDDR, VDD), automatic mode-switch
activations/day ratio, quality of life, OA
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