Original ArticleTachycardia-Related Cardiomyopathy: A Common Cause of Ventricular Dysfunction in Patients With Atrial Fibrillation Referred for Atrioventricular Ablation
Section snippets
PATIENTS AND METHODS
The Ablate and Pace Trial was a multicenter registry of patients with refractory atrial fibrillation referred for clinically indicated radiofrequency atrioventricular node ablation and pacemaker implantation. A total of 161 patients were enrolled at 16 centers in the United States; the results of this study have been reported.9 Patients with atrial fibrillation were deemed candidates for atrioventricular node ablation if, in the opinion of the investigator, medical therapy provided inadequate
RESULTS
Sixty-three patients had systolic dysfunction (ejection fraction (≤5%) and comprised the study population. Of these, 9 died without follow-up. The mean ejection fraction in the patients who died was 30%. Six of these deaths were deemed cardiovascular: 2 sudden deaths, 2 deaths due to heart failure, and 2 deaths due to stroke. Three deaths were deemed noncardiac (prostatic cancer, pancreatitis, and chronic obstructive lung disease). One patient was lost to follow-up, and 5 either did not have
DISCUSSION
In these 63 patients with atrial fibrillation and systolic dysfunction referred for atrioventricular node ablation, systolic dysfunction was reversible in 25%. These data would suggest that reversible systolic dysfunction associated with atrial fibrillation and poor rate control, or “tachycardia-related cardiomyopathy,” is not rare and occurs in roughly one fourth of patients with atrial fibrillation and systolic dysfunction who are referred for atrioventricular ablation. In most patients who
Acknowledgments
The Ablate and Pace Trial Investigators are G. Neal Kay, MD, University of Alabama-Birmingham; Peter J. Wells, MD, Baylor University Heart Place; Mark Josephson, MD, Beth Israel Hospital; George Crossley, MD, Bowman Gray School of Medicine; David Wilber, MD, University of Chicago; Bruce Wilkoff, MD, Cleveland Clinic; Andrea Natale, MD, Durham VA Medical Center; Anne Curtis, MD, University of Florida College of Medicine; Michael Giudici, MD, Genesis Medical Center; Steven Kutalek, MD, Hahnemann
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The Ablate and Pace Trial (APT) was funded by Medtronic Inc, Minneapolis, Minn
Nothing in this publication implies that Mayo Foundation endorses any products of Medtronic Inc mentioned in this article