Atrial fibrillation: radiofrequency modulation of the AV node helped symptoms.

Clinical bottom line (level 4)

  1. 90% of patients with symptomatic atrial fibrillation resistant to drug therapy who received radiofrequency modulation of the AV node were symptom-free at 19 months.
  2. A sixth developed complete AV block.
Morady et al: Journal of the American College of Cardiology 1997; 27 (1): 113-121
Expires November 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

62 patients (aged range 34 to 86 years; mean 65, 52% male) symptomatic atrial fibrillation (palpitations or reduced exercise tolerance) with an uncontrolled ventricular rate resistant to drug therapy

Excluded if
  • symptomatic bradycardia
  • presence of symptoms at rest with a ventricular rate <90 bpm.


    • All patients had radiofrequency modification of the atrioventricular node.

    100% followed for 4 to 33 months (mean 19)
    Outcomes studied:
  • control of ventricular rate at 4 days
  • control of ventricular rate at 19 months
  • AV block at 4 days
  • other complications at 4 days
  • recurrence of symptoms

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    control of ventricular rate at 4 days 4 to 33 months (mean 19) 50/62 81%
    (71% to 90%)
    control of ventricular rate at 19 months 4 to 33 months (mean 19) 45/62 73%
    (61% to 84%)
    AV block at 4 days 4 to 33 months (mean 19) 10/62 16%
    (7.0% to 25%)
    other complications at 4 days 4 to 33 months (mean 19) 2/62 3.2%
    (0.0% to 7.6%)
    recurrence of symptoms 4 to 33 months (mean 19) 5/62 8.1%
    (1.3% to 15%)

    Comments

    1. Failure to compare these patients with a control group makes these results less useful.

    Citation

    1. Morady F, Hasse C, Strickberger A, et al: Long-term follow-up after radiofrequency modification of the atrioventricular node in patients with atrial fibrillation. Journal of the American College of Cardiology 1997; 27 (1): 113-121
    Contributor: Nick Shenker and Chris Ball, November 2000
    Reviewer:

    Clinical Question.
    Patient AF resistant to drug therapy
    Intervention or Exposure radiofrequency modulation of the AV node
    Outcome symptom-free, complications