Synchronized biventricular pacing after av node ablation in CHF patients

Background atrioventricular junctional (AVJ) ablation with PM implantation has been shown to improve quality of life (QoL) in selected patients(pts) with drug resistant atrial fibrillation (AF). However,after the procedure,some pts worsen because of asinchronous ventricular stimulation.History during the last 9 years,among 1986 pts who referred to our Institution for AF, 28 pts underwent ablate and pace procedure by right ventricular single lead.The long term follow up(FU) of 36 months demonstrated an improvement of QoL in all but 4 pts who developed a progressive, irreversible heart failure.Methods from january 2001 to july 2002, 12 consecutive pts (6F,6M of mean age of 70.2 years) with dilated cardiomyopathy and chronic, non controlled high rate AF, were recruited. Eight pts had chronic persistant AF and 4 pts had chronic paroxismal AF. After AVJ ablation, a biventricular device was implanted : Medtronic Insync in 9 pts and Insync biventricular ICD in 3 pts. The NYHA functional class, the QRS duration, the mean heart rate, left ventricular ejection fraction (LVEF) and LV end diastolic dyameter (LVEDD) by 2D echocardiography, 6 minutes walking test(6'WT), the score of Minnesota questionnaire and the score of palpitation symptoms were evaluated at baseline and at 1, 3, 6 and 12 months FU in every pts.Results the mean FU was 7.2+/− 4 months.The results have been quite terrific as shown as follow.One pt,3 months after the procedure, in spite of wide clinical improvements, died suddenly on ecg Holter monitoring that demonstrated a ventricular fibrillation as the cause of death. In pts with paoxismal AF, a trend of reduction of numbers and duration of episodes of AF was observed.View this table:Conclusions these results demonstrated that the AVJ ablation combined with biventricular pacing is an effective tecnique to improve QoL in AF in congestive heart failure pts, mostly by relief of symptoms of palpitations and by means of the resinchronization therapy. The clinical results are not correlated to the QRS duration and to the LVEDD.Also the number of episodes of paroxismal AF seems to be lowered by the resnchronization therapy.However, life threatening ventricular arrhythmias have to be considered in pts without previous episodes.