M. Gasparini, M. Mantica, P.Galimberti, M. Brignole, C.Menozzi, G.Magenta, P. Delise, A.Proclemer, S. Tognarin, R.Ometto.
Unita Operativa di Elettrofisiologia, Istituto Clinico Humanitas, Rozzano Milan, Italy
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Atrial fibrillation (AF) is one of the most common arrhythmias
observed in clinical practice, affecting either patients with or without heart disease, with a prevalence of
6% in over 65 years global population. AF is associated with a two-fold increase in all-cause mortality,
and it is present in 6 to 24% of patients who have an ischemic stroke, and in up to 50% of patients with
cardioembolic strokes. In patients with structural heart disease, such as dilated cardiomyopathy, valvular
heart disease or coronary artery disease, AF frequently induces severe heart failure, while in patients with
normal heart AF is often associated with important symptoms such as palpitations, due to fast ventricular
rate, or easy fatigue and bad “quality of life”, and it is a frequent cause of morbidity.
When the pharmacological approach is not effective in preventing AF or in reducing ventricular rate during
AF, pacemaker (PM) implantation and radiofrequency catheter ablation of the atrioventricular (AV) junction,
can be performed. This procedure, allowing an adequate and regular ventricular rate, can improve heart
function in patients with heart failure and ameliorate symptoms and exercise tolerance in patients without
heart disease1-5. However, unexpected sudden cardiac death (SCD) has been observed in these patients
after ablation, and the possibility that it could be due to AV-block related ventricular tachyarrhythmias is
still debated. Aim of our study was to retrospectively evaluate the incidence of SCD, after AV node ablation
and permanent pacing, in a large cohort of patients, during a long-term follow-up after ablation.
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