PMID- 22436544
OWN - NLM
STAT- MEDLINE
DCOM- 20121005
LR  - 20151119
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 14
IP  - 6
DP  - 2012 Jun
TI  - Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis of 
      biventricular vs. right ventricular pacing mode.
PG  - 661-7
LID - 10.1093/eurjhf/hfs036 [doi]
AB  - AIMS: For patients with refractory atrial fibrillation (AF) undergoing 
      atrioventricular nodal ablation (AVNA), initial single-chamber right ventricular 
      (RV)-only pacing is standard. Given the deleterious effects of chronic RV-only 
      pacing, the impact of an initial biventricular (BiV) pacing strategy 
      post-ablation is of interest. METHODS AND RESULTS: We conducted a meta-analysis 
      to determine the effect of BiV vs. RV-only pacing in patients undergoing AVNA for 
      refractory atrial fibrillation. A search of multiple electronic databases 
      identified 921 reports, which included four randomized controlled trials (n = 
      534). Mean New York Heart Association (NYHA) class was 2.3 and mean left 
      ventricular ejection fraction (LVEF) was 44%. When compared with RV-only pacing, 
      BiV pacing was not associated with reduced mortality [risk ratio 0.85, 95% 
      confidence interval (CI) 0.40-1.82, P = 0.68]. In three studies comprised of 
      patients with left ventricular systolic dysfunction (mean EF 41 +/- 3%), BiV pacing 
      demonstrated a non-significant reduction in cardiac mortality (risk ratio 0.59, 
      95% CI 0.25-1.39; P = 0.23). Compared with RV-only pacing, BiV pacing was 
      associated with significant improvement in symptoms [Minnesota Living with Heart 
      Failure Questionnaire (MLWHFQ) 2.72 points fewer, 95% CI 1.45-3.99] and increased 
      LVEF (+2.6%, 95% CI 1.69-3.44), but no significant change in 6 min walk distance 
      (6MWD) (5.02 ms more, 95% CI -1.56 to 11.59; P = 0.13). CONCLUSIONS: In patients 
      with refractory AF undergoing AVNA, BiV pacing was not associated with 
      significantly improved survival when compared with RV-only pacing. A modest, but 
      significant improvement in structural and functional response to BiV pacing was 
      observed.
FAU - Chatterjee, Neal A
AU  - Chatterjee NA
AD  - Department of Medicine and the Cardiac Arrhythmia Service, Massachusetts General 
      Hospital, Boston, MA 02411, USA.
FAU - Upadhyay, Gaurav A
AU  - Upadhyay GA
FAU - Ellenbogen, Kenneth A
AU  - Ellenbogen KA
FAU - Hayes, David L
AU  - Hayes DL
FAU - Singh, Jagmeet P
AU  - Singh JP
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20120321
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
CIN - Eur J Heart Fail. 2012 Nov;14(11):1311; author reply 1311-2. PMID: 22927637
MH  - Atrial Fibrillation/diagnosis/mortality/*surgery
MH  - Atrioventricular Node/*pathology
MH  - *Cardiac Resynchronization Therapy
MH  - *Catheter Ablation
MH  - Confidence Intervals
MH  - Heart Ventricles/*pathology
MH  - Humans
MH  - Quality of Life
MH  - Risk
MH  - Surveys and Questionnaires
MH  - Treatment Failure
MH  - United States
EDAT- 2012/03/23 06:00
MHDA- 2012/10/06 06:00
CRDT- 2012/03/23 06:00
PHST- 2012/03/23 06:00 [entrez]
PHST- 2012/03/23 06:00 [pubmed]
PHST- 2012/10/06 06:00 [medline]
AID - hfs036 [pii]
AID - 10.1093/eurjhf/hfs036 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2012 Jun;14(6):661-7. doi: 10.1093/eurjhf/hfs036. Epub 2012 Mar 
      21.