Abstract 18468: Atrial Fibrillation Ablation in Patients With Complete Heart Block
Introduction: Atrioventricular node (AVN) ablation with placement of a permanent pacemaker is typically reserved as the final therapeutic approach for patients with symptomatic atrial fibrillation (AF), who have failed both rhythm and pharmacologic rate control. However, some patients continue to experience debilitating symptoms despite ultimate rate control in the setting of complete heart block (CHB). We sought to assess the utility of AF ablation in patients with CHB.
Methods: Between 1/2000 and 5/2015, 48 consecutive patients underwent ablation at our institution for symptomatic refractory AF despite pre-existing CHB and pacer dependence. All patients underwent pulmonary vein isolation, with additional substrate modification as decided by the operators. Echo and clinical data were collected at baseline and at 1 year of follow-up.
Results: Mean age was 63±13 years and 71% were males. Reported median left ventricular ejection fraction was 55%. CHB was due to prior AVN ablation (n=22), valve surgery (N=7), septal myectomy (n=2), slow-pathway ablation (n=1) or other causes (N=16). All but 1 patient had atrial leads in place. Procedural complications occurred in 3 patients (2 pericardial effusions, 1 pulmonary edema). Upon follow-up, AF was detected in 25 patients (53.2%) on device check but only 6 patients (12.8%) had symptomatic recurrences. The median AF burden as quantified on device check prior to ablation was 100% (69-100) and significantly decreased at 1-year post-ablation to 0.05% (0-11) (p<0.0001). Left atrial diameter, ejection fraction and grade of mitral regurgitation did not significantly change from baseline. The median New York Heart Association functional class significantly improved from 2 (2-3) pre ablation to 1 (1-2) at 1-year post ablation (p<0.0001).
Conclusions: AF ablation in patients with pre-existing complete heart block and pacemaker dependence is feasible, significantly decreases AF burden and is associated with clinical improvement in symptomatic patients.
Author Disclosures: A. Barakat: None. K. Abdur Rehman: None. A. Hussein: None. O. Wazni: None. K. Tarakji: None. W. Saliba: Speakers Bureau; Modest; Biosense. Honoraria; Modest; Biosense. Consultant/Advisory Board; Modest; Boston Scientific. B. Lindsay: None. B. Baranowski: None.
- © 2016 by American Heart Association, Inc.