A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation

Konstantinos Vlachos, Konstantinos P Letsas, Panagiotis Korantzopoulos, Tong Liu, Michael Efremidis, Antonios Sideris, Konstantinos Vlachos, Konstantinos P Letsas, Panagiotis Korantzopoulos, Tong Liu, Michael Efremidis, Antonios Sideris

Abstract

Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called "ablate and pace" approach offers the potential for more robust control of ventricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic function. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implantation time, and the proper device selection after atrioventricular junction ablation are also discussed.

Keywords: Ablation; Atrial fibrillation; Atrioventricular junction; Pacemaker.

Figures

Figure 1.. The positions of the AV…
Figure 1.. The positions of the AV node and His bundle in a case.
(A): posterior-anterior fluoroscopic projection showing the position of the ABL at the AV junction as well as a temporary pacing catheter positioned in the RV; (B): intracardiac electrograms recorded at the distal bipole of the ablation catheter (ABL-D) during sinus rhythm showing a large atrial component, a His bundle electrogram (arrows), and a ventricular component; and (C): successful AVJA in patient with AF leading to AV block and paced-rhythm. The presence of AF makes the electrograms difficult to interpret due to the presence of high frequency, small amplitude atrial potentials. ABL: ablation catheter; AF: atrial fibrillation; AV: atrioventricular; AVJA: AV junction ablation; RV: right ventricle.

References

    1. Braunwald E. Shattuck lecture: cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997;337:1360–1369.
    1. Efremidis M, Letsas KP, Lioni L, et al. Association of quality of life, anxiety, and depression with left atrial ablation outcomes. Pacing Clin Electrophysiol. 2014;37:703–711.
    1. Deedwania PC, Lardizabal JA. Atrial fibrillation in heart failure: a comprehensive review. Am J Med. 2010;123:198–204.
    1. Corday E, Gold H, de Vera LB, et al. Effect of the cardiac arrhythmias on the coronary circulation. Ann Intern Med. 1959;50:535–553.
    1. Coleman HN, Taylor RR, Pool PE, et al. Congestive heart failure following chronic tachycardia. Am Heart J. 1971;81:790–798.
    1. Riegger AJG, Liebau G. The renin-angiotensin-aldosterone system, antidiuretic hormone and sympathetic nerve activity in an experimental model of congestive heart failure in the dog. Clin Sci. 1982;62:465–469.
    1. Armstrong PW, Stopps TP, Ford SE, et al. Rapid ventricular pacing in the dog: pathophysiologic studies of heart failure. Circulation. 1986;74:1075–1084.
    1. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347:1834–1840.
    1. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347:1825–1833.
    1. Wood MA, Brown-Mahoney C, Kay GN, et al. Clinical outcomes after ablation and pacing therapy for atrial fibrillation: A meta-analysis. Circulation. 2000;101:1138–1144.
    1. Chatterjee NA, Upadhyay GA, Ellenbogen KA, et al. Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis and systematic review. Circ Arrhythm Electrophysiol. 2012;5:68–76.
    1. Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2011;57:e101–e198.
    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1–e76.
    1. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Eur Heart J. 2010;31:2369–2429.
    1. Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA) Eur Heart J. 2013;34:2281–2329.
    1. Scheinman MM, Huang S. The 1998 NASPE prospective catheter ablation registry. Pacing Clin Electrophysiol. 2000;23:1020–1028.
    1. Curtis AB, Kutalek SP, Prior M, et al. Prevalence and characteristics of escape rhythms after radiofrequency ablation of the atrioventricular junction: results from the registry for AV junction ablation and pacing in atrial fibrillation. Am Heart J. 2000;139:122–125.
    1. Sousa J, El-Atassi R, Rosenheck S, et al. Radiofrequency catheter ablation of the atrioventricular junction from the left ventricle. Circulation. 1991;84:567–571.
    1. Marshall HJ, Griffith MJ. Ablation of the atrioventricular junction: Technique, acute and long-term results in 115 consecutive patients. Europace. 1999;1:26–29.
    1. Souza O, Gürsoy S, Simonis F, et al. Right-sided versus left-sided radiofrequency ablation of the His bundle. Pacing Clin Electrophysiol. 1992;15:1454–1459.
    1. Darpö B, Walfridsson H, Aunes M, et al. Incidence of sudden death after radiofrequency ablation of the atrioventricular junction for atrial fibrillation. Am J Cardiol. 1997;80:1174–1177.
    1. Ozcan C, Jahangir A, Friedman PA, et al. Sudden death after radiofrequency ablation of the atrioventricular node in patients with atrial fibrillation. J Am Coll Cardiol. 2002;40:105–110.
    1. Sadoul N, Blankoff I, de Chillou C, et al. Effects of radiofrequency catheter ablation on patients with permanent pacemakers. J Interv Card Electrophysiol. 1997;1:227–233.
    1. Geelen P, Brugada J, Andries E, et al. Ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction. Pacing Clin Electrophysiol. 1997;20:343–348.
    1. Schumacher B, Pfeiffer D, Tebbenjohanns J, et al. Acute and long-term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter. J Cardiovasc Electrophysiol. 1998;9:152–163.
    1. Blanck Z, Dhala AA, Sra J, et al. Characterization of atrioventricular nodal behavior and ventricular response during atrial fibrillation before and after a selective slow-pathway ablation. Circulation. 1995;91:1086–1094.
    1. Della Bella P, Carbucicchio C, Tondo C, et al. Modulation of atrioventricular conduction by ablation of the “slow” atrioventricular node pathway in patients with drug-refractory atrial fibrillation or flutter. J Am Coll Cardiol. 1995;25:39–46.
    1. Menozzi C, Brignole M, Gianfranchi L, et al. Radiofrequency catheter ablation and modulation of atrioventricular conduction in patients with atrial fibrillation. Pacing Clin Electrophysiol. 1994;17:2143–2149.
    1. Feld GK. Radiofrequency catheter ablation versus modification of the AV node for control of rapid ventricular response in atrial fibrillation. J Cardiovasc Electrophysiol. 1995;6:217–228.
    1. Canby RC, Román CA, Kessler DJ, et al. Selective radiofrequency ablation of the “slow” atrioventricular nodal pathway for control of the ventricular response to atrial fibrillation. Am J Cardiol. 1996;77:1358–1361.
    1. Fleck RP, Chen PS, Boyce K, et al. Radiofrequency modification of atrioventricular conduction by selective ablation of the low posterior septal right atrium in a patient with atrial fibrillation and a rapid ventricular response. Pacing Clin Electrophysiol. 1993;16:377–381.
    1. Proclemer A, Della Bella P, Tondo C, et al. Radiofrequency ablation of atrioventricular junction and pacemaker implantation versus modulation of atrioventricular conduction in drug refractory atrial fibrillation. Am J Cardiol. 1999;83:1437–1442.
    1. Lee SH, Chen SA, Tai CT, 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. J Am Coll Cardiol. 1998;31:637–644.
    1. Bongiorni MG, Proclemer A, Dobreanu D, et al. Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace. 2013;15:1664–1668.
    1. Proclemer A, Facchin D, Pagnutti C, et al. Safety of pacemaker implantation prior to radiofrequency ablation of atrioventricular junction in a single session procedure. Pacing Clin Electrophysiol. 2000;23:998–1002.
    1. Kay GN, Bubien RS, Epstein AE, et al. Effect of catheter ablation of the atrioventricular junction on quality of life and exercise tolerance in paroxysmal atrial fibrillation. Am J Cardiol. 1988;62:741–744.
    1. Brignole M, Gianfranchi L, Menozzi C, et al. Influence of atrioventricularjunction radiofrequency ablation in patients with chronic atrial fibrillation and flutter on quality of life and cardiac performance. Am J Cardiol. 1994;74:242–246.
    1. Fitzpatrick AP, Kourouyan HD, Siw A, et al. Quality of life and outcomes after radiofrequency His-bundle catheter ablation and permanent pacemaker implantation: impact of treatment in paroxysmal and established atrial fibrillation. Am Heart J. 1996;131:499–507.
    1. Kay GN, Ellenbogen KA, Giudici M, et al. The Ablate and Pace Trial: A prospective study of catheter ablation of the AV conduction system and permanent pacemaker implantation for treatment of atrial fibrillation. J Interv Card Electrophysiol. 1998;2:121–135.
    1. Bedotto JB, Grayburn PA, Black WH, et al. Alterations in left ventricular relaxation during atrioventricular pacing in humans. J Am Coll Cardiol. 1990;15:658–664.
    1. Karpawich PP, Rabah R, Haas JE. Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. Pacing Clin Electrophysiol. 1999;22:1372–1377.
    1. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288:3115–3123.
    1. Barsheshet A, Moss AJ, McNitt S, et al. Long-term implications of cumulative right ventricular pacing among patients with an implantable cardioverter-defibrillator. Heart Rhythm. 2011;8:212–218.
    1. Chen L, Hodge D, Jahangir A, et al. Preserved left ventricular ejection fraction following atrioventricular junction ablation and pacing for atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19:19–27.
    1. Abraham WT, Fisher WG, Smith AL, et al. MIRACLE Study Group Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845–1853.
    1. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–2150.
    1. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873–880.
    1. Gras D, Leclercq C, Tang AS, et al. Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study. Eur J Heart Fail. 2002;4:311–320.
    1. Higgins SL, Hummel JD, Niazi IK, et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol. 2003;42:1454–1459.
    1. Linde C, Leclercq C, Rex S, et al. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol. 2002;40:111–118.
    1. Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003;289:2685–2694.
    1. Doshi RN, Daoud EG, Fellows C, et al. PAVE Study Group Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study) J Cardiovasc Electrophysiol. 2005;16:1160–1165.
    1. Molhoek SG, Bax JJ, Bleeker GB, et al. Comparison of response to cardiac resynchronization therapy in patients with sinus rhythm versus chronic atrial fibrillation. Am J Cardiol. 2004;94:1506–1509.
    1. Gasparini M, Auricchio A, Regoli F, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol. 2006;48:734–743.
    1. Tolosana JM, Hernandez Madrid A, Brugada J, et al. Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study) Am J Cardiol. 2008;102:444–449.
    1. Gasparini M, Auricchio A, Metra M, et al. Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation. Eur Heart J. 2008;29:1644–1652.
    1. Ferreira AM, Adragao P, Cavaco DM, et al. Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation. Europace. 2008;10:809–815.
    1. Dong K, Shen WK, Powell BD, et al. Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy. Heart Rhythm. 2010;7:1240–1245.
    1. Delnoy PP, Ottervanger JP, Luttikhuis HO, et al. Comparison of usefulness of cardiac resynchronization therapy in patients with atrial fibrillation and heart failure versus patients with sinus rhythm and heart failure. Am J Cardiol. 2007;99:1252–1257.
    1. Khadjooi K, Foley PW, Chalil S, et al. Long-term effects of cardiac resynchronization therapy in patients with atrial fibrillation. Heart. 2008;94:879–883.
    1. Schutte F, Ludorff G, Grove R, et al. Atrioventricular node ablation is not a prerequisite for cardiac resynchronization therapy in patients with chronic atrial fibrillation. Cardiology. 2009;16:246–249.
    1. Reddy VY, Knops RE, Sperzel J, et al. Permanent leadless cardiac pacing: results of the leadless trial. Circulation. 2014;129:1466–1471.

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