RT-148
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Long-term clinical effects of
A-V junctional ablation in patients with supraventricular arrhythmias
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Gaetano Barbato, Rocco Fernando
Guaragna, Elena Negrini, Giampiero Nobile, Maria Gabriella Camplese, Daniele Bracchetti.
Sezione di Cardiologia, Ospedale Maggiore, Bologna, Italy
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Abstract
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The purpose of this study was to evaluate the
long-term effects of radiofrequency A-V junctional ablation (AVJ) in patients (pts) with
supraventricular arrhythmias.
Patients and methods. Seventy-two pts (37 male and 35 female) having
mean age of 72.5 ± 6.8 underwent AVJ because of high rate supraventricular arrhythmias.
At the time of the ablation 38 pts were in NYHA class 1, 31, 2 and 1 in NYHA class II, III
and IV respectively. The arrhythmia presented was atrial fibrillation in 65 cases, atrial
flutter in 4 and atrial tachycardia in 3. In 69 cases the arrhythmia was associated with
structural heart diseases. In 59 pts a permanent pacemaker was implanted after AVJ (12
DDD, 32 VVIR, 2 DDDR, 8 VVI, 5 DDI). Ten pts already had a pacemaker before AVJ. The
ablation was performed from the right ventricle in 66 pts and from the left ventricle in 6
pts. In 3 pts the procedure was not successful. Seventy-one out of 72 pts were alive after
3.3 ± 1.5 years. All the patients underwent a first complete clinical examination
including echocardiogram 15 days after the ablation and we compared these data with a
second clinical check performed 24 months later.
Results. The results of the first and second echocardiogram were
respectively: EF 60.63 ± 13.05 vs 60.50 ± 12.67 (p ns), left atrium 40.7 ± 6.13 vs
45.39 ± 6.02 (p ns), left ventricle diastolic diameter 52.24 ± 7.18 vs 52.61 ± 6.92 (p
ns), left ventricle systolic diameter 35.27 ± 7.53 vs 35.22 ± 7.39 (p ns). Four pts
presented subsequent (12-19 months after the ablation) cardiac failure and they had to be
treated for this reason. During the follow-up, only 2 pts died: 1 NYHA IV class pt died
after 15 months because of cardiac failure, the other patient died after 26 months because
of non cardiac disease. In 1 pt in whom a pacemaker already had been implanted before
JABL, the ventricular pacing threshold increased immediately after JABL from 1.0
pre-ablation to 2.0 V post-ablation and this value did not change during the follow-up.
Discussion. All the pts indicated that they experienced a dramatic
improvement in their quality of life during the post-ablation period, as compared with the
time before the ablation. We did not observe any significant improvement of the
ventricular performance in patients with heart failure during the follow-up. Two NYHA II
class pts became class III and the only patient who was in NYHA IV class before the
ablation died of congestive cardiac failure during the follow-up. On the other hand, it
must be emphasized that all the pts who presented good ventricular function at the time of
JABL did not present signs or symptoms of cardiac failure during the follow-up.
Conclusions. JABL appears to be a safe and effective approach in pts
with high rate supraventricular arrhythmias, particularly in patients with a good
ventricular function. Long-term follow-up in pts who underwent AVJ shows that artificial
AV block and pacemaker pacing do not worsen ventricular performance when the ventricular
function is normal at the time of the ablation. In pts with compromised ventricular
function, although we observed an improvement of the symptoms after AVJ, we did not
document any significant long-term improvement in left ventricular performance.
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Key Words
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Atrial fibrillation – RF catheter ablation
of AV junction
supraventrucular arrhythmias, pacemaker (DDD, VVIR mode), ventricular function, NYHA
class, echocardiography, dicumarol, OA
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