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Predictors of hospitalization for heart failure and of all-cause mortality after atrioventricular nodal ablation and right ventricular pacing for atrial fibrillation
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
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2014 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 16, no 12, p. 1772-1778Article in journal (Refereed) Published
Abstract [en]

Aims: Atrioventricular junction ablation (AVJA) is a highly effective treatment in patients with therapy refractory atrial fibrillation (AF) but renders the patient pacemaker dependent. We aimed to analyse the long-term incidence of hospitalization for heart failure (HF) and all-cause mortality in patients who underwent AVJA because of AF and to determine predictors for HF and mortality.

Methods and results: We retrospectively enrolled 162 consecutive patients, mean age 67 +/- 9 years, 48% women, who underwent AVJA because of symptomatic AF refractory to pharmacological treatment (n = 117) or unsuccessful repeated pulmonary vein isolation (n = 45). Hospitalization for HF occurred in 32 (20%) patients and 35 (22%) patients died, representing a cumulative incidence for hospitalization for HF and mortality over the first 2 years after AVJA of 9.1 and 5.2%, respectively. Hospitalization for HF occurred to the same extent in patients who failed pharmacological treatment as in patients with repeated pulmonary vein isolation (PVI), although the mortality was slightly higher in the former group. QRS prolongation >= 120 ms and left atrial diameter were independent predictors of hospitalization for HF, while hypertension and previous HF were independent predictors of death.

Conclusion: The long-term hospitalization rate for HF and all-cause mortality was low, which implies that long-term ventricular pacing was not harmful in this patient population, including patients with unsuccessful repeated PVI.

Place, publisher, year, edition, pages
Oxford University Press, 2014. Vol. 16, no 12, p. 1772-1778
Keywords [en]
Atrial fibrillation, Atrioventricular junction ablation, Heart failure, Hospitalization, Mortality
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-42367DOI: 10.1093/europace/euu171ISI: 000347104900016PubMedID: 25031234OAI: oai:DiVA.org:oru-42367DiVA, id: diva2:785867
Note

Funding Agency:

Örebro Heart Foundation

Research Committee of Örebro University Hospital

Available from: 2015-02-04 Created: 2015-02-03 Last updated: 2018-06-15Bibliographically approved
In thesis
1. Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
Open this publication in new window or tab >>Catheter ablation for atrial fibrillation: effects on rhythm, symptoms and health-related quality of life
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: AF ablation is an increasingly used treatment in patients with AF to improve patient-reported outcomes (PROs). Atrioventricular junction ablation (AVJA) is a palliative treatment option in therapy refractory AF that improves PROs but renders the patient pacemaker dependent.

Aims: To evaluate rhythm control and PROs before and up to two years after AF ablation. To analyze the long-term incidence of and predictors of hospitalization for HF and all-cause mortality in patients who underwent AVJA and right ventricular pacing.

Methods and Results: Fifty-four patients underwent AF ablation and both continuous rhythm monitoring via an implantable loop recorder (ILR) and intermittent rhythm monitoring three, six, 12 and 24 months after ablation. 76 % of patients had at least one AF recurrence, of whom 24 % were only detected by ILR. One third of symptom recordings did not show AF. The AF-specific AF6 scores, physician-assessed EHRA symptom class and both SF-36 summary scores all improved significantly from before to two years after ablation. There was a weak correlation between the change in AF6 scores and EHRA class from before to six and 12 months but not to 24 months after ablation. Responders to ablation (AF burden < 0.5 %), reached age- and sex-matched norms in all SF-36 domains, but non-responders only in social functioning and MCS. All AF6 scores showed at least moderate improvement in both responders and non-responders. Higher AF burden was independently associated with poorer PCS and AF6 scores. In 162 patients who underwent AVJA, hospitalization for HF occurred in 20 % of patients (two-year cumula-tive incidence 9.1 %) and 22 % died (two-year cumulative incidence 5.2 %) during a median follow-up of five years. QRS ≥ 120 ms and left atrial diame-ter were independent predictors of hospitalization for HF, and hypertension and previous HF of death.

Conclusions: Continuous rhythm monitoring was superior to intermittent monitoring. The AF-specific AF6 was more sensitive to changes related to AF burden after AF ablation than both EHRA class and the SF-36. The long-term hospitalization rate for HF and all-cause mortality was low after AVJA.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 92
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 175
Keywords
Atrial fibrillation, catheter ablation, symptoms, quality of life
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-65015 (URN)978-91-7529-237-3 (ISBN)
Public defence
2018-04-20, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Supervisors
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-03-28Bibliographically approved

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Björkenheim, AnnaAndersson, TommyWandt, BirgerPoci, Dritan

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