Pulmonary veins isolation is a well-established AF treatment, although delayed referral of patients, particularly those with longstanding persistent AF, may reduce its efficacy. 4,5 Currently, in patients with supraventricular arrhythmias who are unresponsive or intolerant to pharmacological therapy, rhythm control may be achieved with electrical cardioversion and catheter ablation. 3 Clinical trials have demonstrated that in about one quarter of these patients, an adequate rate control strategy cannot be achieved. 1,2 AF promotes heart failure (HF) decompensation leading to hospitalizations, and 10-40% of AF patients are hospitalized every year. Supraventricular arrhythmias present a challenge for the management of patients who develop a high ventricular rate and symptoms refractory to medical therapy.Ītrial fibrillation (AF) is the most frequent sustained arrhythmia in clinical practice. Provavelmente, a ANAV deveria ser considerada mais cedo no tratamento de doentes com disritmias supraventriculares e IC, sobretudo nos casos em que a ablação seletiva da disritmia seja inapropriada. O número de recursos ao SU por IC antes do procedimento foi preditor do composto de eventos adversos. ConclusõesĪpesar da dependência de pacemaker, o benefício clínico da ANAV persistiu a longo prazo. O número de recursos ao SU por IC antes do procedimento foi preditor independente do composto de eventos adversos (OR 1,8, IC95%, 24-2,61, p=0,002). Apesar da estimulação permanente de pacemaker, a FEVE não agravou (47%☑3 versus 47%☑2, p=0,63). Não houve complicações relacionadas ao dispositivo. Num período mediano de seguimento de 8,5 anos (intervalo interquartil 3,8-11,8), houve melhoria da classe funcional de insuficiência cardíaca (IC) (classe NYHA III-IV 46% versus 13%, p = 0,001) e redução dos internamentos por IC (0,98☑,3 versus 0,28☐,8, p=0,001), redução dos recursos ao serviço de urgência (SU) (1,1☑ versus 0,17☐,7, p=0,0001). A maioria apresentou fibrilhação auricular (65%). Resultadosįoram submetidos 123 doentes à ANAV: idade média 69 ± 9 anos e 52% homens. MétodosĪnálise retrospetiva detalhada, dos doentes submetidos à ANAV entre fevereiro 1997 e fevereiro 2019, num centro terciário português. ObjetivosĪvaliar os resultados em longo prazo após a ANAV e analisar preditores de eventos adversos. Nos doentes com disritmias supraventriculares e frequência ventricular elevada, irresponsivos à terapêutica para controlo da frequência e do ritmo, ou à ablação por catéter, a ablação do nódulo auriculoventricular (ANAV) pode ser realizada. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. Conclusionsĭespite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002). Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47☑3% vs. There were no device-related complications. During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF)įunctional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98☑.3 versus 0.28☐.8, p=0.001) and emergency department (ED) visits (1.1☑ versus 0.17☐.7, p=0.0001). Most of them presented atrial fibrillation at baseline (65%). ResultsĪ total of 123 patients, mean age 69☙ years and 52% male, underwent AV node ablation. We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center. To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events. In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed.
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