Catheter Ablation of AV Junction with Radiofrequency Energy and Pacemaker Implantation in Patients with Paroxysmal Atrial Fibrillation

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Abstract

Atrial fibrillation is the most common sustained arrhythmia in clinical practice. It is associated with significant consumption of health care resources and severe complications, such as stroke. It was our objective to assess the efficacy and safety of radiofrequency ablation of the AV node with subsequentpace maker implantation in patients with drug refractory paroxysmal atrial fibrillation. We studied 23 patients (15 males, mean age 65, range 30 to 89). All had been treated with 2 to 5 antiarrhythmic agents (including amiodarone in 95%). Ablation was achieved with a unipolar right-sided approach in 22cases and with a bipolar right to left approach in one. No acute complications occurred. AV block was obtained in 95% of cases, with the emergence on a junctional rhythm at 45 beats per minute. One patient required a second ablation session to achieve complete AV block. Eighteen patients received anew pacemaker (17 DDDR and 1 VVIR), whereas 5 patients had preexistent units (2 DDDR and 3 VVI). After a mean follow up of 20 months, AV conduction recovered in one patient, but with a long PR and Wenckebach block at low rates. Another patient developed atrial lead dislodgment requiring repositioning. Symptoms, heart failure, use of antiarrhythmic drugs and rehospitalizations were reduced significantly.