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a Department of
Cardiology, Royal Brompton and Harefield NHS Trust, Harefield Hospital,
Harefield, Middlesex, UB9 6JH, UK, b Department of Cardiology, Eastbourne District
General Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD,
UK
Correspondence to: Dr Levy terry{at}levy77.freeserve.co.uk
Accepted 27 September
2000
OBJECTIVE
To determine the importance
of rhythm regulation or rate control in patients with permanent atrial
fibrillation (AF) and normal left ventricular function.
PATIENTS AND INTERVENTIONSThirty six
patients with a mixed fast and slow ventricular response rate to their
AF were randomised to either His bundle ablation (HBA) and VVIR
pacemaker (HBA group) or VVI pacemaker and atrioventricular modifying
drugs (Med group). Outcomes assessed at one, three, six, and 12 months
included exercise duration and quality of life.
RESULTSExercise duration
significantly improved from baseline in both groups. There was no
difference in outcome between the groups (Med +40%
v HBA +20%, p = NS). The heart rate profile
on exercise was similarly slowed in both groups compared to baseline.
Quality of life significantly improved in both treatment arms for the modified Karolinska questionnaire (KQ) (Med +50%
v HBA +50%, p = NS) and the Nottingham
health profile (NHP) (Med +40% v HBA +20%,
p = NS). However, for the individual symptom scores of each questionnaire more were improved in the Med group (KQ-Med 6 improved v HBA 4, NHP-Med 3 v
HBA 1). Left ventricular function was equally preserved by both
treatments during follow up.
CONCLUSIONIn these patients control
of ventricular response rate with either HBA + VVIR pacemaker or
atrioventricular modifying drugs + VVI pacemaker will lead to a
significant improvement in exercise duration and quality of life.
Rhythm regulation by HBA did not confer additional benefit, suggesting
rate control alone is necessary for the successful symptomatic
treatment of these patients in permanent AF.
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