Randomized controlled trial of fixed rate versus rate responsive pacing after radiofrequency atrioventricular junction ablation: quality of life, ventricular refractoriness, and paced QT dispersion.
INTRODUCTION: Ablation of the AV junction is a widely accepted treatment of drug-refractory atrial fibrillation. Long-term pacing of the right ventricular (RV) apex following AV junction ablation can result in adverse cardiac remodeling. However, anecdotal studies report that pacing too slowly follo...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 14; no. 11; pp. 1163 - 1171 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2003
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106752752&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106752752 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Nov2003 vid: 14 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 106752752 2004113171 10.1046/j.1540-8167.2003.03168.x NLM14678128 106752752 ppf: 1163 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Randomized controlled trial of fixed rate versus rate responsive pacing after radiofrequency atrioventricular junction ablation: quality of life, ventricular refractoriness, and paced QT dispersion. aug: au: Duff HJ Raj SR Exner DV Sheldon RS Roach D Mitchell LB Wyse DG Morck M Gillis AM affil: University of Calgary, Health Sciences Centre, HSC 1632, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1; hduff@ucalgary.ca sug: subj: Atrial Fibrillation Therapy Cardiac Pacing, Artificial Evaluation Catheter Ablation Utilization Aged Analysis of Variance Clinical Trials Descriptive Statistics Electrocardiography Exercise Tolerance Female Fisher's Exact Test Funding Source Heart Conduction System Physiopathology Heart Ventricle Pathology Heart Ventricle Physiopathology Male Middle Age Pilot Studies Quality of Life Questionnaires Scales Short Form-36 Health Survey (SF-36) Tachycardia, Ventricular Epidemiology Two-Tailed Test Unpaired T-Tests Human Aged: 65+ years Middle Aged: 45-64 years Female Male ab: INTRODUCTION: Ablation of the AV junction is a widely accepted treatment of drug-refractory atrial fibrillation. Long-term pacing of the right ventricular (RV) apex following AV junction ablation can result in adverse cardiac remodeling. However, anecdotal studies report that pacing too slowly following AV junction ablation was associated with propensity to sudden cardiac death. The aim of this study was to provide information about the balance between measures of quality of life versus measures of electrical remodeling achieved by pacing with different rate modalities in a randomized pilot clinical trial. METHODS AND RESULTS: Patients with permanent atrial fibrillation were randomized to VVI (80 beats/min) versus VVIR (minimum rate 80 beats/min), whereas patients with paroxysmal atrial fibrillation were randomized to DDI versus DDDR pacing at discharge from hospital. Serially, measurements of exercise capacity, quality of life, cycle length dependence of QT dispersion (QTdisp), RV refractoriness, and the incidence of nonsustained ventricular tachycardia were made in 28 patients over a 6-month follow-up period. Time-dependent increases in QTdisp were observed in patients randomized to the rate responsive mode (RR-ON) but only when paced at 40 beats/min. This was paralleled by time-dependent increases in RV refractoriness (270 +/- 11 ms at baseline to 302 +/- 5 ms at 6 months) in patients with RR-ON. RR-ON also was associated with trends to an increasing incidence of episodes of nonsustained ventricular tachycardia and worsening of some measures of quality of life. Exercise capacity was not substantially different in the randomized groups. CONCLUSION: Rate responsive pacing results in electrical remodeling of the ventricle following AV junction ablation, but exercise capacity was similar in groups with RR-ON or RR-OFF. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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