Atrial fibrillation: paroxysmal: patients felt better with AV junction ablation and a pacemaker rather than AV junction modification

Clinical bottom line (level 1b)

  1. Patients with paroxysmal atrial fibrillation resistant to medical therapy who received a complete AV junction ablation and a permanent pacemaker compared with AV junction modification had fewer significant symptoms and felt they had a better quality of life.
Lee et al: Journal of the American College of Cardiology 1998; 31 (3): 637-644
Expires November 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: acute hospital, Taiwan

60 patients (aged mean 67, 75% male) with medically refractory paroxysmal atrial fibrillation or chronic atrial fibrillation

Excluded if
  • indication for a permanent pacemaker (AF with long pauses or symptomatic bradycardia)


    • Control Group: (n = 30, 30 analysed): complete AV junction ablation with permanent pacing
    Experimental Group: (n = 30, 30 analysed): AV junction modification

    100% followed for 15 months

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    frequency of significant attacks 0.70
    (0.80)     		1.40
    (0.90)     		0.7
    (0.3 to 1.1)
    general quality of life 1.0
    (0.80)     		1.70
    (0.70)     		0.7
    (0.3 to 1.1)

    Comments

    1. All patients had an improvement in symptoms following therapy.
    2. Quality of life was scored from 0 to 3 (no symptoms to severe symptoms).

    Citation

    1. Lee S-H, Chen S-A, Tai C-T, et al: Comparisons of quality of life and cardiac performance after complete atrioventricular junction ablation and atrioventricular junction modification in patients with medically refractory atrial fibrillation. Journal of the American College of Cardiology 1998; 31 (3): 637-644
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer:

    Clinical Question.
    Patient paroxysmal atrial fibrillation resistant to medical therapy
    Intervention or Exposure AV junction modification
    Comparison AV junction ablation with permanent pacemaker
    Outcome frequency of attacks and quality of life