Pulmonary vein isolation superior to AV node ablation and biventricular pacing in atrial fibrillation with heart failure

Pulmonary vein isolation superior to AV node ablation: Pulmonary vein isolation has been found to be superior to AV node ablation and biventricular pacing in atrial fibrillation with heart failure in a study published in NEJM today [1]. PABA-CHF Investigators evaluated pulmonary vein isolation vs AV node ablation and biventricular pacing in patients with drug refractory atrial fibrillation and heart failure with ejection fraction of 40% or less and NYHA functional class of II or III. Minnesota Living with Heart Failure Questionnaire was used to assess the quality of life (QOL). The scores in the questionnaire ranged from 0 – 105, with higher score indicating poorer QOL. This QOL score along with echocardiographic ejection fraction and the distance walked on 6 minute walk test constituted the composite primary end point of the study. Symptomatic and asymptomatic episodes of atrial fibrillation over a 6 month period was also noted. There were 41 patients in the pulmonary-vein isolation ablation group and 40 in the atrioventricular-node ablation with biventricular pacing group.

QOL score was 60 in the pulmonary vein isolation group while it was 82 in the AV node ablation with biventricular pacing group (P<0.001) at 6 months. 6 minute walk distance was 340 m and 297 m respectively (P<0.001) and the ejection fraction was also higher in the pulmonary vein isolation group (35% vs 28%, P<0.001). In the pulmonary vein isolation group 88% of those receiving antiarrhythmic drugs and 71% of those not receiving those drugs were free of atrial fibrillation at the end of 6 months. The overall complication rates were small and similar in both groups.

Reference

  1. Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO, Kautzner J, Hao S, Themistoclakis S, Fanelli R, Potenza D, Massaro R, Wazni O, Schweikert R, Saliba W, Wang P, Al-Ahmad A, Beheiry S, Santarelli P, Starling RC, Dello Russo A, Pelargonio G, Brachmann J, Schibgilla V, Bonso A, Casella M, Raviele A, Haïssaguerre M, Natale A; PABA-CHF Investigators. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 2008 Oct 23;359(17):1778-85.