(Circulation. 2000;101:1138.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Clinical Outcomes After Ablation and Pacing Therapy for Atrial Fibrillation
A Meta-Analysis
From Virginia Commonwealth University/Medical College of Virginia (M.A.W., K.A.E.); the University of Minnesota, Minneapolis (C.B.-M.); and the University of Alabama, Birmingham (G.N.K.).
Correspondence to Mark A. Wood, MD, Medical College of Virginia, PO Box 980053, Richmond, VA 23298-0053.
Background—Radiofrequency ablation of the atrioventricular node and permanent pacing are used for symptomatic relief in patients with medically refractory atrial fibrillation. In this study, meta-analysis was used to clarify clinical outcomes and survival after ablation and pacing therapy using data from the published literature.
Methods and Results—We used 21 studies with a total of 1181 patients in the meta-analysis. All patients had medically refractory atrial tachyarrhythmias, primarily atrial fibrillation (97%). Nineteen measures of clinical outcome, encompassing quality of life, ventricular function, exercise duration, and healthcare use, were derived from the studies. The meta-analysis demonstrated significant improvement after ablation and pacing therapy in all outcome measures except fractional shortening, which demonstrated a trend toward improvement (P=0.08). Ejection fraction did show significant improvement (P<0.001). The calculated 1-year total and sudden death mortality rates after ablation and pacing therapy were 6.3% and 2.0%, respectively.
Conclusions—Ablation and pacing therapy improves a broad range of clinical outcomes for patients with medically refractory atrial fibrillation. The calculated 1-year mortality rates after this therapy are low and comparable with medical therapy.
Key Words: ablation • pacing • fibrillation • clinical trials • survival
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