Preserved left ventricular ejection fraction following atrioventricular junction ablation and pacing for atrial fibrillation

Lin Chen, David Hodge, Arshad Jahangir, Cevher Ozcan, Jane Trusty, Paul Andrew Friedman, Robert Rea, David John Bradley, Peter Brady, Stephen Hammill, David Hayes, Win Kuang Shen

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Preserved LVEF After AVJ Ablation and RVA Pacing. Introduction: Right ventricular apical (RVA) pacing creates ventricular dyssynchrony and may compromise left ventricular ejection fraction (LVEF). The impact of RVA pacing in patients who have undergone atrioventricular junction (AVJ) ablation for atrial fibrillation (AF) is unclear. We sought to determine whether RVA pacing after AVJ ablation for patients with AF compromises LVEF in the short- or long-term. Methods/Results: We studied 286 patients with AF who underwent AVJ ablation and RVA pacing at our institution between 1990 and 2002. Patients were stratified into a short-term follow-up group (LVEF reassessed by echocardiography within a year after AVJ ablation, n = 134) and a long-term group (LVEF reassessed after a year, n = 152). Among all 286 patients (mean follow-up 20 months), we observed no change in mean LVEF after AVJ ablation and RVA pacing (48% before vs. 48% after, P = 0.42). Short-term follow-up patients had a statistically significant improvement in mean LVEF (46% before vs. 49% after, P = 0.03), whereas there was no statistically significant change in mean LVEF in long-term follow-up patients (49% before vs. 48% after, P = 0.37). Only 9% of short-term patients, 15% of long-term patients, and 1% of patients with baseline LVEF ≤ 40% experienced ≥10% absolute decrease in LVEF. Baseline LVEF > 40% was a multivariate predictor of LVEF decline. Conclusions: RVA pacing after AVJ ablation does not compromise LVEF in the short- or long-term for the vast majority of patients. Better predictors are needed to help us select patients for biventricular pacing after AVJ ablation.

Original languageEnglish (US)
Pages (from-to)19-27
Number of pages9
JournalJournal of Cardiovascular Electrophysiology
Volume19
Issue number1
DOIs
StatePublished - Jan 2008

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Stroke Volume
Atrial Fibrillation
Cardiac Resynchronization Therapy
Echocardiography

Keywords

  • Atrial fibrillation
  • Atrioventricular junction ablation
  • Left ventricular ejection fraction
  • Right ventricular apical pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Preserved left ventricular ejection fraction following atrioventricular junction ablation and pacing for atrial fibrillation. / Chen, Lin; Hodge, David; Jahangir, Arshad; Ozcan, Cevher; Trusty, Jane; Friedman, Paul Andrew; Rea, Robert; Bradley, David John; Brady, Peter; Hammill, Stephen; Hayes, David; Shen, Win Kuang.

In: Journal of Cardiovascular Electrophysiology, Vol. 19, No. 1, 01.2008, p. 19-27.

Research output: Contribution to journalArticle

Chen, Lin ; Hodge, David ; Jahangir, Arshad ; Ozcan, Cevher ; Trusty, Jane ; Friedman, Paul Andrew ; Rea, Robert ; Bradley, David John ; Brady, Peter ; Hammill, Stephen ; Hayes, David ; Shen, Win Kuang. / Preserved left ventricular ejection fraction following atrioventricular junction ablation and pacing for atrial fibrillation. In: Journal of Cardiovascular Electrophysiology. 2008 ; Vol. 19, No. 1. pp. 19-27.
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abstract = "Preserved LVEF After AVJ Ablation and RVA Pacing. Introduction: Right ventricular apical (RVA) pacing creates ventricular dyssynchrony and may compromise left ventricular ejection fraction (LVEF). The impact of RVA pacing in patients who have undergone atrioventricular junction (AVJ) ablation for atrial fibrillation (AF) is unclear. We sought to determine whether RVA pacing after AVJ ablation for patients with AF compromises LVEF in the short- or long-term. Methods/Results: We studied 286 patients with AF who underwent AVJ ablation and RVA pacing at our institution between 1990 and 2002. Patients were stratified into a short-term follow-up group (LVEF reassessed by echocardiography within a year after AVJ ablation, n = 134) and a long-term group (LVEF reassessed after a year, n = 152). Among all 286 patients (mean follow-up 20 months), we observed no change in mean LVEF after AVJ ablation and RVA pacing (48{\%} before vs. 48{\%} after, P = 0.42). Short-term follow-up patients had a statistically significant improvement in mean LVEF (46{\%} before vs. 49{\%} after, P = 0.03), whereas there was no statistically significant change in mean LVEF in long-term follow-up patients (49{\%} before vs. 48{\%} after, P = 0.37). Only 9{\%} of short-term patients, 15{\%} of long-term patients, and 1{\%} of patients with baseline LVEF ≤ 40{\%} experienced ≥10{\%} absolute decrease in LVEF. Baseline LVEF > 40{\%} was a multivariate predictor of LVEF decline. Conclusions: RVA pacing after AVJ ablation does not compromise LVEF in the short- or long-term for the vast majority of patients. Better predictors are needed to help us select patients for biventricular pacing after AVJ ablation.",
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AU - Chen, Lin

AU - Hodge, David

AU - Jahangir, Arshad

AU - Ozcan, Cevher

AU - Trusty, Jane

AU - Friedman, Paul Andrew

AU - Rea, Robert

AU - Bradley, David John

AU - Brady, Peter

AU - Hammill, Stephen

AU - Hayes, David

AU - Shen, Win Kuang

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N2 - Preserved LVEF After AVJ Ablation and RVA Pacing. Introduction: Right ventricular apical (RVA) pacing creates ventricular dyssynchrony and may compromise left ventricular ejection fraction (LVEF). The impact of RVA pacing in patients who have undergone atrioventricular junction (AVJ) ablation for atrial fibrillation (AF) is unclear. We sought to determine whether RVA pacing after AVJ ablation for patients with AF compromises LVEF in the short- or long-term. Methods/Results: We studied 286 patients with AF who underwent AVJ ablation and RVA pacing at our institution between 1990 and 2002. Patients were stratified into a short-term follow-up group (LVEF reassessed by echocardiography within a year after AVJ ablation, n = 134) and a long-term group (LVEF reassessed after a year, n = 152). Among all 286 patients (mean follow-up 20 months), we observed no change in mean LVEF after AVJ ablation and RVA pacing (48% before vs. 48% after, P = 0.42). Short-term follow-up patients had a statistically significant improvement in mean LVEF (46% before vs. 49% after, P = 0.03), whereas there was no statistically significant change in mean LVEF in long-term follow-up patients (49% before vs. 48% after, P = 0.37). Only 9% of short-term patients, 15% of long-term patients, and 1% of patients with baseline LVEF ≤ 40% experienced ≥10% absolute decrease in LVEF. Baseline LVEF > 40% was a multivariate predictor of LVEF decline. Conclusions: RVA pacing after AVJ ablation does not compromise LVEF in the short- or long-term for the vast majority of patients. Better predictors are needed to help us select patients for biventricular pacing after AVJ ablation.

AB - Preserved LVEF After AVJ Ablation and RVA Pacing. Introduction: Right ventricular apical (RVA) pacing creates ventricular dyssynchrony and may compromise left ventricular ejection fraction (LVEF). The impact of RVA pacing in patients who have undergone atrioventricular junction (AVJ) ablation for atrial fibrillation (AF) is unclear. We sought to determine whether RVA pacing after AVJ ablation for patients with AF compromises LVEF in the short- or long-term. Methods/Results: We studied 286 patients with AF who underwent AVJ ablation and RVA pacing at our institution between 1990 and 2002. Patients were stratified into a short-term follow-up group (LVEF reassessed by echocardiography within a year after AVJ ablation, n = 134) and a long-term group (LVEF reassessed after a year, n = 152). Among all 286 patients (mean follow-up 20 months), we observed no change in mean LVEF after AVJ ablation and RVA pacing (48% before vs. 48% after, P = 0.42). Short-term follow-up patients had a statistically significant improvement in mean LVEF (46% before vs. 49% after, P = 0.03), whereas there was no statistically significant change in mean LVEF in long-term follow-up patients (49% before vs. 48% after, P = 0.37). Only 9% of short-term patients, 15% of long-term patients, and 1% of patients with baseline LVEF ≤ 40% experienced ≥10% absolute decrease in LVEF. Baseline LVEF > 40% was a multivariate predictor of LVEF decline. Conclusions: RVA pacing after AVJ ablation does not compromise LVEF in the short- or long-term for the vast majority of patients. Better predictors are needed to help us select patients for biventricular pacing after AVJ ablation.

KW - Atrial fibrillation

KW - Atrioventricular junction ablation

KW - Left ventricular ejection fraction

KW - Right ventricular apical pacing

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