Comparisons of quality of life and cardiac performance after complete atrioventricular junction ablation and atrioventricular junction modification in patients with medically refractory atrial fibrillation

Objectives. This study compared the long-term effects of complete atrioventricular junction (AVJ) ablation with those of AVJ modification in patients with medically refractory atrial fibrillation (AF). Background. Comparisons between the long term effects of AVJ ablation with those of AVJ modification in patients with medically refractory AF have not been systematically studied. Methods. Sixty patients with medically refractory AF were randomly assigned to receive complete AVJ ablation with permanent pacing or AVJ modification. Subjective perception of quality of life (QOL) was assessed by a semiquantitative questionnaire before and 1 and 6 months after ablation. Cardiac performance was evaluated by echocardiography and radionuclide angiography within 24 h (baseline) and at 1 and 6 months after ablation. Results. Both methods were associated with significant improvement in general QOL and a significant reduction in the frequency of major symptoms and symptoms during attacks. The frequency of hospital admission and emergency room visits and antiarrhythmic drug trials significantly decreased after ablation in both groups. However, patients after complete AVJ ablation had a significantly greater improvement in general QOL and a significantly reduced frequency of major symptoms and symptoms during attacks (including palpitation, dizziness, chest oppression, blurred vision and syncope). Left ventricular (LV) systolic function and the ability to perform activities of daily life significantly improved after ablation in patients with depressed LV function in both groups. All improvements after ablation or modification were maintained over the 6-month follow-up period. Conclusions. AVJ ablation with permanent pacing, as compared with AVJ modification, had a significantly greater ability to decrease the frequency of attacks and the extent of symptoms of AF, and the patients who received this procedure were more satisfied with their general well-being. (C) 1998 by the American College of Cardiology.