Thromboembolism after atrioventricular node ablation and pacing: long term follow up
M Gasparinia, M Manticaa, M Brignoleb, L Gianfranchib, C Menozzic, F Pizzettid, G Magentae, P Delisef, A Proclemerg, S Tognarinh, R Omettoi, F Acquatij, R Mantovank, P Turcoa, G M De Ferraril
a Department of
Cardiology, Istituto Clinico Humanitas, 56 Rozzano, 20089 Milan, Italy, b Department of Cardiology, Ospedali Riuniti,
Lavagna, Italy, c Department of Cardiology, Ospedale S Maria
Nuova, Reggio Emilia, Italy, d Department
of Cardiology, Santo Spirito Hospital, Casale Monferrato, Italy, e "De Gasperis" Department
of Cardiology Niguarda Hospital, Milan, Italy, f Department of Cardiology, Ospedale Feltre,
Belluno, Italy, g Department of
Cardiology, Udine Hospital, Italy, h Department of Cardiology, Piombino Hospital,
Italy, i Department of
Cardiology, Vicenza Hospital, Italy, j Department of Cardiology, Ospedale di Circolo
Varese, Italy, k Department of
Cardiology, Pontesampiero Hospital, Italy, l Department of Cardiology, IRCCS Policlinico S
Matteo Pavia, Italy
Correspondence to: Dr Gasparini. email: maurizio.gasparini{at}humanitas.it
Accepted for publication 12 April 1999
OBJECTIVE
To assess
the incidence of arterial embolic events in patients with high rate,
drug resistant, severely symptomatic paroxysmal and chronic atrial
fibrillation who have undergone atrioventricular (AV) node
ablation and permanent pacing.
DESIGNMulticentre
retrospective cohort study.
PATIENTS AND
MANAGEMENTFrom May 1987 to January 1997, AV node
ablation was performed in 585 severely symptomatic patients (mean (SD)
age 66 (11) years) with high rate, drug resistant paroxysmal atrial
fibrillation (308) or chronic atrial fibrillation (277). Lone atrial
fibrillation was present in 133 patients, while the remaining 452 suffered from dilated, ischaemic, or valvar heart disease. Patients
underwent VVIR (454) or DDDR (131) pacemaker implantation, after AV
node ablation. Antiplatelet agents were given to 202 patients, warfarin to 187 patients.
RESULTSDuring a
follow up of 33.6 (24.2) months, thromboembolic events were observed in
17 patients (3%); the actuarial occurrence rates of thromboembolism
were 1.1%, 3%, 4.2%, and 7.4% after one, three, five, and seven
years, respectively. Among five variables, univariate analysis showed
that only the presence of chronic atrial fibrillation at the time of
ablation (relative risk (RR) = 1.8, 95% confidence interval
(CI) = 1.02 to 3.20, p = 0.04) and the need for warfarin treatment
(RR = 1.6, 95% CI 1.00 to 2.71, p = 0.048) were associated with a
significantly higher risk of occurrence of thromboembolic events. On
multivariate analysis the only predictor of embolic events during the
follow up was the presence of chronic atrial fibrillation.
CONCLUSIONSData from
this large cohort of patients indicate a fairly low incidence (1.04%
per year) of thromboembolic events after AV node ablation and pacing
for drug refractory, high rate atrial fibrillation.
Keywords: atrial fibrillation; embolism; atrioventricular node ablation; pacemaker implantation
© 1999 by Heart
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