Is there a role for bi-atrial pacing resynchronisation therapy in the management of drug-refractory atrial fibrillation in patients unsuitable for left atrial ablation?

Abstract

BACKGROUND:

This retrospective cohort study evaluated whether long term outcome of atrial resynchronisation therapy using bi-atrial pacing (BiaP) to treat atrial fibrillation (AF) was effective in patients deemed unfit for left atrial (LA) ablation procedures.

METHODS AND RESULTS:

The patient population comprised 2 groups: those deemed suitable for left LA ablation (n=14) and those who were not (n = 17). Both groups underwent BiaP and outcomes were evaluated by comparing symptoms, AF duration, admissions and antiarrhythmic drugs (AAD) for an equal period of time pre and post implantation. Median follow-up was 24 months (range 8-66 months) for the unsuitable group and 31 months (range 7-84 months) for the suitable group. Efficacy in reduction of both AF and symptoms was similar (P = 0.44) in both groups (unsuitable group: 13/17; suitable group: 8/14). There was significant improvement in median AF episodes/week pre and post BiaP in both groups (unsuitable group AF reduction: 5 days/week, P = 0.001; suitable group AF reduction: 4.9 days/week, P = 0.03); the improvement was similar in both groups (P = 0.33). There was a significant reduction in the median number of admissions for AF in both groups (unsuitable group: P = 0.003; suitable group: P = 0.01) and this reduction was also similar (P = 0.70). The median number of AAD was also reduced to a similar degree (P = 0.83) in both groups (suitable group: P = 0.004; unsuitable group: P = 0.001).

CONCLUSIONS:

Atrial resynchronisation therapy is effective in the long term management of drug-resistant AF in patients unsuitable for LA ablation, leading to significant reductions in symptoms, AF duration, admissions and AAD.

• Authors: Rajiv Sankaranarayanan, Michael Anthony James, Hanney Gonna, Stephanie Burtchaell, Russell Holloway, Paul Ewings
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 75 Issue 1 Pg. 67-72 ( 2011) ISSN: 1347-4820 [Electronic] Japan
• PMID: 21127382 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Aged
• Aged, 80 and over
• Anti-Arrhythmia Agents (therapeutic use)
• Atrial Fibrillation (drug therapy, physiopathology, surgery, therapy)
• Cardiac Resynchronization Therapy (adverse effects)
• Catheter Ablation (adverse effects)
• Drug Resistance
• England
• Female
• Hospitalization
• Humans
• Male
• Middle Aged
• Patient Selection
• Recurrence
• Retrospective Studies
• Risk Assessment
• Time Factors
• Treatment Outcome