Heart 1998;79:543-547 ( June )

Atrioventricular nodal ablation and implantation of mode switching dual chamber pacemakers: effective treatment for drug refractory paroxysmal atrial fibrillation

H J Marshall, Z I Harris, M J Griffith, M D Gammage

Department of Cardiovascular Medicine, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK

Correspondence to: Dr Marshall.

Accepted for publication 31 December 1997

ObjectiveTo assess the effect of atrioventricular node ablation and implantation of a dual chamber, mode switching pacemaker on quality of life, exercise capacity, and left ventricular systolic function in patients with drug refractory paroxysmal atrial fibrillation.
Patients18 consecutive patients with drug refractory paroxysmal atrial fibrillation.
MethodsQuality of life was assessed before and after the procedure using the psychological general wellbeing index (PGWB), the McMaster health index (MHI), and a visual analogue scale for cardiac symptoms. Nine of the patients also underwent symptom limited exercise tests and echocardiography to assess left ventricular systolic function.
ResultsThe procedure allowed a reduction in antiarrhythmic drug treatment (p < 0.01). PGWB and symptom scores improved (p < 0.01) but the MHI score did not change. Left ventricular systolic function and exercise capacity were unchanged.
ConclusionsAtrioventricular node ablation and implantation of a DDDR/MS pacemaker is effective treatment for refractory paroxysmal atrial fibrillation, producing improved quality of life while allowing a reduction in drug burden. The popularity of the treatment is justified, but further studies are needed to determine optimum timing of intervention.

Keywords: paroxysmal atrial fibrillation;  drug refractoriness;  atrioventricular node ablation;  dual chamber pacemaker

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© 1998 by Heart
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