TY - JOUR
T1 - Pulmonary-vein isolation for atrial fibrillation in patients with heart failure
AU - Khan, Mohammed N.
AU - Jaïs, Pierre
AU - Cummings, Jennifer
AU - Di Biase, Luigi
AU - Sanders, Prashanthan
AU - Martin, David O.
AU - Kautzner, Josef
AU - Hao, Steven
AU - Themistoclakis, Sakis
AU - Fanelli, Raffaele
AU - Potenza, Domenico
AU - Massaro, Raimondo
AU - Wazni, Oussama
AU - Schweikert, Robert
AU - Saliba, Walid
AU - Wang, Paul
AU - Al-Ahmad, Amin
AU - Beheiry, Salwa
AU - Santarelli, Pietro
AU - Starling, Randall C.
AU - Dello Russo, Antonio
AU - Pelargonio, Gemma
AU - Brachmann, Johannes
AU - Schibgilla, Volker
AU - Bonso, Aldo
AU - Casella, Michela
AU - Raviele, Antonio
AU - Haïssaguerre, Michel
AU - Natale, Andrea
PY - 2008/10/23
Y1 - 2008/10/23
N2 - Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)
AB - Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)
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U2 - 10.1056/NEJMoa0708234
DO - 10.1056/NEJMoa0708234
M3 - Article
C2 - 18946063
AN - SCOPUS:54949104627
SN - 0028-4793
VL - 359
SP - 1778
EP - 1785
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 17
ER -