Early haemodynamic changes after radiofrequency ablation of the atrioventricular junction

Česká verzia

Authors: S. Mišíková ¹; B. Stančák ¹; E. Komanová ²
Authors place of work: Východoslovenský ústav srdcových a cievnych chorôb, Košice, Slovenská republika, Arytmologické oddelenie, prednosta prim. MUDr. Branislav Stančák, CSc. ¹; III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, CSc. ²
Published in the journal: Vnitř Lék 2007; 53(9): 947-953
Category: Original Contributions

Summary

Introduction:
The effect of radiofrequency ablation of the atrioventricular junction may be accompanied by undesired effect of right ventricular stimulation. The objective of the study was to evaluate early haemodynamic effects of catheter ablation in patients with permanent atrial fibrillation resistant to pharmacotherapy.

Method:
The study included 19 patients aged 66.9 ± ± 12.4 years on an average. Depending on the basal ejection fraction (EF), we divided the patients in to two groups (the 1st group patients had EF less than 50 %, the 2nd group patients had EF equal to 50 % or higher). The patients were underwent radiofrequency ablation of the atrioventricular junction and a pacemaker implantation. Haemodynamic changes were evaluated by measuring the ejection volume (EV) and the minute volume (MV) using echocardiography basally prior to and after the intervention, at different stimulation frequencies. For a more precise evaluation of the patients’ condition, we defined the EVi am MVi indices as the ratio between the above values at different stimulation frequencies and the basal value.

Outcome:
EV in patients with a low EF increases at all stimulation frequencies with the maximum effect observed in the frequency band from 60–100/min. At stimulation frequency of 60/min, the volume increased from 26.4 ml before ablation to 39.5 ml after ablation. MV grows or remains unchanged at all frequencies except for 60/min, at which the growth in EV cannot compensate the drop in MV due to a fall in frequency. Patients in the 2nd group had a high EV value (52.3 ml) before ablation. After the intervention, their EV increased only at stimulation frequency of 60 and 80/min (64.0 and 55.1 ml, respectively). Also these patients’ MV was high before ablation (6,097 ml). After the intervention, their MV decreased for all stimulation frequencies, but showed a growing tendency. Statistical evaluation showed negative correlation between EVi and MVi on the one hand, and between EF and the average of the left ventricle in systole on the other.

Conclusion:
Our results have shown that radiofrequency transcatheter ablation of the atrioventricular node (RFCA AVN) is beneficial for certain patients in both the groups, even though the mechanisms of improving their clinical condition are different.

Key words:
atrial fibrillation – AVN ablation – permanent cardiostimulation – minute volume

Zdroje

1. Chugh SS, Blackshear JL, Shen WK et al. Epidemiology and natural history of atrial fibrillation: Clinical implication. JACC 2001; 37: 371-378.

2. van der Berg MP, Hassink RJ, Tuinenburg AE et al. Quality of life in patients with paroxysmal atrial fibrillation and its predictors: importance of the autonomic nervous system. Eur Heart J 2001; 22: 247-253.

3. Špinar J, Vítovec J. Fibrilace síní. Vnitř Lék 2003; 49: 748-753.

4. Guerra PG, Lesh MD. The role of nonpharmacologic therapies for the treatment of atrial fibrillation. J Cardiovasc Electrophysiol 1999; 10: 450-460.

5. Pappone C, Rosanio S. Pulomonary vein isolation for atrial fibrillation. In: Zipes DP, Jalife J. Cardiac Electrophysiology. From cell to bedside. 4. ed. Philadelphia: Saunders 2004: 1039-1052.

6. Haissaguerre M, Hocini M, Sanders P et al. Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 2005; 16: 1138-1147.

7. Ouyang F, Ernst S, Chun J et al. Electrophysiological findings during ablation of persistent atrial fibrillation with electroanatomic mapping and double Lasso catheter technique. Circulation 2005; 112: 3038-3048.

8. Gaynor SL, Schuessler RB, Bailey MS et al. Surgical treatment of atrial fibrillation: Predictors of late recurrence. J Thorac Cardiovasc Surg 2005; 129: 104-111.

9. Schuchert A, Boriani G, Wollmann C et al. Implantable dual-chamber defibrillator for the selective treatment of spontaneous atrial and ventricular arrhythmias: arrhythmia incidence and device performance. Interv Card Electrophysiol 2005; 12: 149-156.

10. Scheinman MM, Morady F, Gonzales R. Catheter-induced ablation of the atrioventricular junction to control refractory supraventricular arrhythmias. JAMA 1982; 248: 851-855.

11. Stančák B, Pella J, Rešetár J et al. Skúsenosti s abláciou supraventrikulárnych tachydysrytmií jednosmerným a rádiofrekvenčným prúdom. Vnitř Lék 1996; 42: 779-783.

12. Stančák B, Mišíková S, Schroner Z et al. Faktory ovplyvňujúce vulnerabilitu ľavej predsiene pri rýchlej transezofageálnej stimulácii predsiení. Vnitř lék 1994; 40: 3-8.

13. DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Int Med 1916; 17: 863-871.

14. Teichholz LE, Kreulen T, Herman MV et al. Problems in echocardiographic volumes determination: echocardiographic-angiographic correlation in the presence or absence of asynergy. Am J Cardiol 1976; 37: 7-11.

15. Brookes CI, White PA, Staples M et al. Myocardial contractility is not constant during spontaneous AF in patients. Circulation 1998; 98: 1762-1768.

16. Verma A, Newman D, Geist M et al. Effects of rhythm regularization and rate control in improving left ventricular function in atrial fibrillation patients undergoing atrioventricular nodal ablation. Can J Cardiol 2001; 17: 437-445.

17. Fuster V, Rydén LE et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. JACC 2001; 38: 1231-1266.

18. Daoud EG, Weiss R, Bahu M et al. Effect of an irregular ventricular rhythm on cardiac output. Am J Cardiol 1996; 78: 1433-1436.

19. Vuolteenaho O, Ala-Kopsala M, Ruskoaho H. BNP as a biomarker in heart disease. Adv Clin Chem 2005; 40: 1-36.

20. Takahashi Y, Yoshiko I, Takahashi A et al. AV nodal ablation and pacemaker implantation improves hemodynamic function in atrial fibrillation. PACE 2003; 26: 1212-1217.

21. Wood MA, Brown-Mahoney C, Kay GN et al. Clinical outcomes after ablation and pacing therapy for atrial fibrillation. A meta-analysis. Circuation 2000; 101: 1138-1144.

22. Wood MA, Kay GN, Ellenbogen KA. The North American experience with the Ablate and Pace trial (APT) for medically refractory atrial fibrillation. Europace 1999; 1: 22-25.

23. Flaker GC, Blackshear JL, McBride R. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. J Am Coll Cardiol 1992; 20: 232-237.

24. Grogan M, Smith HC, Gersh BJ et al. Left ventricular dysfunction due to atrial fibrillation in patients initially believed to have idiopathic dilated cardiomyopathy. Am J Cardiol 1992; 69: 1570-1573.

25. Adomian GE, Beazell J. Myofibrillar disarray produced in normal hearts by chronic electrical pacing. Am Heart J 1986; 112: 79-83.

26. Karpawich PP, Rabah R, Haas JE. Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. PACE 1999; 22: 1372-1377.

27. Szilli-Torok T, Kimman GP, Theuns D et al. Deterioration of left ventricular function following atrioventricular node ablation and right ventricular apical pacing in patients with permanent atrial fibrillation. Europace 2002; 4: 61-65.

28. Doshi RN, Daoud EG, Fellows C et al. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 2005; 16: 1160-1165.

29. Ritter O, Koller ML, Fey B et al. Progression of heart failure in right univentricular pacing compared to biventricular pacing. Int J Cardiol 2005; in press.

30. O´Donnel D, Nadurata V, Hamer A et al. Bifocal right ventricular cardiac resynchronization therapies in patients with unsuccessful percutaneous lateral left ventricular venous access. Pacing Clin Electrophysiol 2005; 28(Suppl 1): 27-30.

31. Fiala M, Chovančík J, Neuwirth R et al. Katetrizačný ablace fibrilace síní: naděje pro všechny výrazne symptomatické pacienty. Kardiolog revue 2006; 8(suppl): 28-32.

32. Cappato R, Calkins H, Chen S-A et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 2005; 111: 1100-1105.

33. Veselka J, Bartůněk P Prevence tromboembolie u pacientů s fibrilací síní. Vnitř Lék 1996; 42: 792-795.