Abstract 12352: Atrioventricular Node Ablation and Biventricular Pacing Improves Heart Failure in Patients With Refractory Atrial Fibrillation and Non-Ischemic but not Ischemic Cardiomyopathy
Introduction: AV node ablation (AVNAb) with biventricular (BiV) pacing is effective in the treatment of patients with refractory AF with a rapid ventricular response and CHF. Though prior studies have shown that cardiac resynchronization therapy is more efficacious in patients with nonischemic cardiomyopathy (NICM) vs. ischemic cardiomyopathy (ICM), our study is the first to compare the response of patients in these groups with refractory AF to AVNAb and BiV pacing.
Hypothesis: We assessed the hypothesis that, in patients with refractory AF and CHF, AVNAb with BiV pacing would improve heart failure to a greater degree in NICM vs. ICM.
Methods: This was a single-center study of 45 patients with refractory AF and rapid ventricular response, NYHA class III/IV CHF, and an EF≤35% who underwent AVNAb and Bi-V ICD implantation from 2001 to 2008. Patients were classified as ICM if there was definitive EKG and clinical evidence of previous myocardial infarction and/or significant coronary artery disease involving ≥2 major epicardial arteries at cardiac catheterization. Otherwise, patients were classified as NICM. Eighteen were categorized as ICM, and 27 as NICM. Patients underwent echocardiographic evaluation of EF pre-procedure, and after at least 6 months follow-up. Appropriate ICD therapies and post-procedure hospitalizations for decompensated CHF were also analyzed.
Results: Mean follow-up was 20.26 ± 14.21 months. Follow-up EF was significantly higher in the NICM compared with the ICM group (45 ± 10.81 vs. 25.57 ± 12.61; p≤0.0001). Hospitalizations for decompensated CHF were significantly more common in the ICM compared with the NICM group (2.8 ± 0.43 vs 0.4 ± 0.92; p≤0.0001). Appropriate ICD therapies were significantly more common in the ICM compared to the NICM group (64.7% vs. 29.6% of patients, p=0.01).
Conclusions: The results of our study indicate that EF improves to a greater degree in patients with refractory AF and NICM compared with ICM after AVNAb and BiV pacing. In conclusion, these findings indicate that tachycardia-related cardiomyopathy likely plays a more central role in the development of CHF in patients with NICM, while in those with ICM, AF is more likely to act as an aggravant.
- Atrial fibrillation
- Heart failure
- Bi-ventricular pacing
- Implantable cardioconvert defibrillator
- Arrhythmias, treatment of
- © 2013 by American Heart Association, Inc.