Abstract 23234: Clinical Outcomes Following Ablation of the Atrioventricular Junction: Impact of Cardiac Resynchronization Therapy
Introduction: Many patients (pts) with atrial fibrillation (AF) undergo pacemaker (PM) implant. In some pts, atrioventricular junction (AVJ) ablation (abl) is performed concurrently. We investigate (1) the impact of AVJ abl on subsequent risk of AF or heart failure (HF) hospitalization (hosp) and (2) whether these endpoints differ in pts with a right ventricular (RV) vs. cardiac resynchronization therapy (CRT) PM.
Methods: A MarketScan® (MS) Commercial and Medicare Supplemental claims database was used to select pts 18-100 yrs implanted with a RV or CRT PM from 4/2008 to 3/2014. Pts with AF diagnosis in the year prior to implant and with ≥1 yr continuous MS enrollment pre and post implant were dichotomized into those who did (“AVJ”) or did not (“no AVJ”) undergo abl on the same day as PM implant. AVJ and no AVJ pts were propensity score matched on age, gender, region, implant year, baseline comorbidities, and AF and HF hosp rates in the year prior to abl. The subsequent risk of AF or HF hosp was compared based on inpatient claims.
Results: The study cohort included 26,680 pts (77 ± 11 yrs, 54% male), with a RV (n=25,682) or CRT (n=998) PM; overall, 1,210 (4.5%) pts underwent AVJ abl. Over 2.5 ± 1.1 yrs, AVJ abl was associated with a reduced risk of AF hosp (RV PM HR 0.38 [95% CI 0.25-0.59] p<0.001; CRT PM HR 0.24 [95% CI 0.10-0.58] p=0.002) compared to no AVJ abl. However, the risk for HF hosp was increased for RV PM pts (HR 1.42 [95% CI 1.15-1.76] p=0.001); this was not observed in pts who received a CRT PM (HR 0.78 [95% CI 0.48-1.26] p=0.31).
Conclusion: This nationwide, observational study is the largest cohort of AVJ abl pts ever reported and the first to report the impact of AVJ abl on these clinical outcomes. All pts had a known history of AF. AVJ abl was associated with significantly lower AF hosp. However, in RV PM pts, this benefit was offset by an increased risk of HF hosp. This detrimental response was not observed in pts receiving CRT PM. These data have important implications for AF pts undergoing PM implant.
Author Disclosures: S. Mittal: Consultant/Advisory Board; Modest; St. Jude Medical. D.L. Musat: None. M.H. Hoskins: Consultant/Advisory Board; Modest; St. Jude Medical. J.B. Prillinger: Employment; Significant; St. Jude Medical. Ownership Interest; Significant; Medtronic. G.J. Roberts: Employment; Significant; St. Jude Medical. Y. Nabutovsky: Employment; Significant; St. Jude Medical. Ownership Interest; Significant; St. Jude Medical. F.M. Merchant: None.
- © 2016 by American Heart Association, Inc.