Cardiac electrophysiology review最新文献

{"title":"The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial: rationale, design, results, clinical implications and lessons for future trials.","authors":"Bruce L Wilkoff","doi":"10.1023/B:CEPR.0000023165.20987.b1","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023165.20987.b1","url":null,"abstract":"<p><p>T he Dual Chamber and VVI Implantable Defibrillator (DAVID) trial randomized 506 patients and tested the hypothesis that the dual-chamber pacing mode would produce improved hemodynamics and would in turn reduce congestive heart failure, heart failure hospitalizations, heart failure deaths, atrial fibrillation, strokes, ventricular arrhythmias, and total mortality compared to backup ventricular pacing in patients indicated for implantable defibrillator therapy. Patients had either primary prevention indications (47%) or secondary prevention indications (53%) for implantable defibrillator therapy but had no indications for bradycardia pacemaker support. All the patients had moderate to severe left ventricular dysfunction with a left ventricular ejection fraction of 40% or less (mean = 27%) and were consistently treated with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers (86%) and beta adrenergic blocking agents (85%). The primary combined endpoint of hospitalization for congestive heart failure or death was paradoxically increased and statistically significant ( p = 0.03) at one year in the patients paced in the dual chamber mode (22.6%) compared to patients randomized to ventricular backup pacing (13.3%). Both heart failure hospitalization and mortality contributed outcome. Another perspective would consider this a randomized controlled study of presence or absence of pacemaker therapy in patients with left ventricular dysfunction and indications for implantable defibrillator therapy. Ventricular backup pacing produced less than 3% ventricular and no atrial pacing, while dual chamber pacing produced approximately 60% atrial and ventricular paced heart beats. The poor outcome in the dual chamber paced group correlated with the percentage of right ventricular pacing and suggests that right ventricular pacing caused ventricular dyssynchrony. The poor outcome associated with right ventricular pacing compared to intrinsic activation in the control group of the DAVID trial is reminiscent of the poor outcome associated with prolonged intraventricular conduction activation in the control groups compared to biventricular pacing in the intervention groups of the cardiac resynchronization trials. The direct conclusion from these results are that patients with indications for implantable defibrillators and no indication for pacing should not be paced in the dual chamber pacing mode. It is not appropriate to conclude that only single chamber implantable defibrillators should be implanted. There are other potential advantages to having an implanted atrial lead including improved secondary outcomes. However the DAVID trial results suggest that the dual chamber paced mode was not associated with improved quality of life or decreased frequency of hospitalization, inappropriate shocks from the defibrillator or atrial fibrillation. The more important question is what is the optimal pacing mode in these patients? The AAIR mode is u","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"468-72"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023165.20987.b1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of rapid atrial pacing for termination of drug refractory atrial fibrillation: results of a dual chamber implantable cardioverter defibrillator trial.","authors":"Michael R Gold,&nbsp;Robert B Leman,&nbsp;David E Euler","doi":"10.1023/B:CEPR.0000023134.41562.79","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023134.41562.79","url":null,"abstract":"<p><p>There is increasing interest in the use of an implantable cardioverter defibrillator (ICD) to manage atrial tachyarrhythmias. Although device-based shock therapy is highly effective in terminating persistent atrial tachyarrhythmias, atrial overdrive pacing may also be useful, particularly when this therapy is applied early after the onset of an arrhythmia. A dual-chamber ICD (Medtronic 7250 Jewel AF(R)) has been studied in 267 patients with drug-refractory symptomatic AF. The patients were enrolled as part of multicenter clinical trial to evaluate the safety and efficacy of the device to manage atrial tachyarrhythmias in the absence of a standard ventricular ICD indication. The device discriminates atrial tachycardia (AT) from atrial fibrillation (AF) based on cycle length and regularity, and employs multiple methods of atrial overdrive pacing as well as shocks to terminate tachyarrhythmia episodes. Patients were followed for an average of 15.8 +/- 9.3 months. A majority (63%) of patients presented with a history of persistent AF and 34% presented with a history of paroxysmal AF. The pacing therapies terminated 54% of AT episodes and 27% of AF episodes. In patients with persistent AF, 75% of the AT/AF episodes that were successfully terminated by pacing lasted <or=9 minutes. When the pacing therapies failed, episodes lasted for several hours and 50% of the episodes received at least one shock. The results of this trial suggest that pace-termination plays an important role in device-based management of atrial tachyarrhythmias. It is estimated that early pace-termination of AT/AF episodes may reduce the need for device-based shocks among patients with persistent AF by about half.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"341-4"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023134.41562.79","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral anticoagulants vs. aspirin for stroke prevention in patients with non-valvular atrial fibrillation: the verdict is in.","authors":"Carl van Walraven,&nbsp;Robert G Hart,&nbsp;Daniel E Singer,&nbsp;Peter J Koudstaal,&nbsp;Stuart Connolly","doi":"10.1023/B:CEPR.0000023143.98705.ee","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023143.98705.ee","url":null,"abstract":"<p><p>There is an increased risk of stroke and other cardiovascular events in patients with atrial fibrillation (AF). Three meta-analyses of randomized clinical trials (RCTs) comparing oral anticoagulants (OAC) with aspirin (ASA) arrived at different conclusions regarding the relative efficacy of these agents to prevent ischemic stroke in AF patients. This article summarizes a recently published individual patient meta-analysis of all published RCTs comparing OAC and ASA in AF. In total, 4052 patients randomized to OAC or ASA were similar regarding important prognostic factors. Patients receiving OAC had a significantly lower risk of any stroke (hazard ratio [HR] 0.54 [95% CI 0.43-0.71]), ischemic stroke (HR 0.48 [0.37-0.63]), or cardiovascular events (HR 0.71 [0.59-0.85]). Patients receiving OAC were more likely to experience major bleeding (HR 1.71 [1.21-2.41]). The benefit of OAC was most prominent in patients at a high risk of stroke and other cardiovascular events, such as patients with hypertension, diabetes, or previous cerebrovascular events. Overall, OAC improves outcomes for cardiovascular events in AF patients but modestly increases the absolute risk of major bleeding. Since high-risk AF patients appear to benefit most from OAC, determining stroke risk in AF patients is very important.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"374-8"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023143.98705.ee","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisite atrial pacing for atrial fibrillation prevention: where to go from here?","authors":"Anand Ramdat Misier,&nbsp;Willem P Beukema,&nbsp;Roger Willems","doi":"10.1023/B:CEPR.0000023132.72125.ca","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023132.72125.ca","url":null,"abstract":"<p><p>Atrial fibrillation (AF) is a common arrhythmia associated with stroke, increased mortality and with a negative impact on quality of life. Pharmacologic treatments for AF have not provided long-term relief from arrhythmia recurrence. Multi-site atrial pacing was introduced by Daubert and colleagues about 10 years ago for the treatment of severe atrial conduction delays in patients with sick sinus syndrome. They found that this type of atrial stimulation reduced or prevented AF. Multi-site atrial pacing results in reduction of intra-atrial and interatrial conduction differences and diminishes heterogeneity of refractoriness, i.e. atrial resynchronization. Acute electrophysiological studies have shown that biatrial stimulation reduced AF inducibility. The Dutch Dual-site Right Atrial Pacing for Prevention of Atrial Fibrillation study was a prospective randomized crossover trial comparing the recurrences of AF in dual-site right atrial and single-site high right atrial pacing in patients with symptomatic medically refractory AF, without or with minimal structural heart disease. Patients were randomized to initial dual-site pacing (Group I n = 18) or initial single-site (Group II n = 22) pacing. After 6 months or after a study endpoint was reached patients were crossed over to the other pacing modality.Although, the arrhythmia free intervals were longer for dual-site pacing during both treatments periods (Group I 162 +/- 12 and Group II 114 +/- 15 days) compared to single-site pacing (Group I 143 +/- 16 and Group II 97 +/- 10 days) the difference was not statistically significant (p = 0.061). However, the sequence of the randomized treatment periods had a significant effect on outcome (p < 0.02). Event free intervals (AF > 48 hours requiring electrical cardioversion) were longer during dual-site pacing in both groups compared to single-site stimulation but the difference was statistically not significant (p = 0.055) because of treatment interaction (P < 0.05). To establish the clinical benefits of multi-site pacing for the treatment of patients with medically refractory symptomatic AF, additional prospective randomized studies are needed. Trials with a parallel design are necessary to avoid carry-over effects of different stimulation protocols.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"329-32"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023132.72125.ca","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of atrial antitachycardia functions for treating atrial fibrillation: observations in patients with a dual-chamber defibrillator.","authors":"Renato Ricci,&nbsp;Carlo Pignalberi,&nbsp;Massimo Santini","doi":"10.1023/B:CEPR.0000023136.45408.24","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023136.45408.24","url":null,"abstract":"<p><p>In patients with conventional indication for ICD implantation, atrial fibrillation may occur in more than 50% during the life-span of the device and may lead to severe adverse events. Dual chamber defibrillators with atrial antitachycardia functions, including prevention algorithms, arrhythmia detection capability and atrial therapy options (antitachy pacing and cardioversion) have been recently introduced. The aim of this review is to examine the effectiveness of these new devices and to identify patients who may benefit. We recently studied 112 patients who received the device because of life-threatening ventricular arrhythmias. Fifty-five percent of them had atrial fibrillation prior to implantation. During the follow-up (one year on average), 27% had at least one episode of sustained atrial tachyarrhythmia. Effectiveness of atrial antitachy pacing was 71% on regular atrial tachycardia and 36% on irregular atrial tachyarrhythmias. Atrial shock efficacy was over 90% when adequately programmed. Interestingly, near half of the episodes started as regular atrial tachycardia and accelerated and became less organized in few minutes. Early delivery of antitachy pacing may increase success rate and decrease the need for atrial shock. Furthermore, it may prevent atrial remodeling and reduce atrial fibrillation burden. Based on our experience, we recommend that all patients with a class I indication for defibrillator implantation (related to risk of ventricular arrhythmias) who have a history of or are at risk of developing atrial tachyarrhythmias should receive a dual chamber defibrillator equipped with atrial antitachycardia functions. Furthermore, patients either with a history of heart failure, with poor functional capacity (functional class III or IV), depressed left ventricular ejection fraction, a need for monitoring of atrial rhythm, or in whom there is some concern about appropriate detection of ventricular arrhythmias, may benefit from a single device capable of managing ventricular and supraventricular arrhythmias.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"348-51"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023136.45408.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing specificity without sacrificing sensitivity: potential benefits of using microvolt T-wave alternans testing to risk stratify the MADIT-II population.","authors":"Richard J Cohen","doi":"10.1023/B:CEPR.0000023161.35685.68","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023161.35685.68","url":null,"abstract":"<p><p>The MADIT-II study (Moss et al., N Engl J Med 2002;346:877-883) demonstrated that implantation of a cardioverter/defibrillator (ICD) reduced mortality from 19.8% to 14.2% during 20 months of follow-up in patients with prior myocardial infarction and left ventricular ejection fraction <or=0.30. Concerns have been raised both about the cost and potential morbidity of implanting ICDs in a large group of patients when only a small fraction of the patients would be expected to benefit from the treatment. This concern has given rise to the hope that an effective means of risk stratifying the MADIT-II population might be developed so that ICD therapy can be directed to only those patients who are at significant risk and thus likely to benefit from treatment for purposes of primary prevention of arrhythmic death. Electrophysiology study (EPS) is probably not suitable for this purpose because of its established relatively high false negative rate and because it is itself an invasive procedure. QRS width has been proposed for this purpose but prospective data demonstrating its effectiveness in stratifying the MADIT-II population for risk of arrhythmic death are absent. Initial data suggest that microvolt T-wave alternans (MTWA) testing does appear to be a suitable candidate for risk stratifying the MADIT-II population. These data indicate that approximately 30% of the MADIT-II population test negative for MTWA and that these patients are at extremely low risk for sudden cardiac death and cardiac arrest. Furthermore, MTWA is an inexpensive non-invasive test which can be repeated over time to monitor whether a patient who initially tests negative develops arrhythmic risk with the progression of the underlying disease. As studies of MTWA testing in the MADIT-II population come to publication, a database will likely be formed which will establish MTWA as an effective means of stratifying the MADIT-II population. ICD therapy may not be indicated in patients who test MTWA negative, and conversely the remaining patients may enjoy a greater mortality benefit than that observed in the MADIT-II trial. Furthermore, widespread MTWA testing might have the further benefit in those patients who do not test negative of serving as a call to action to referring physicians to direct those patients to ICD therapy, thereby greatly increasing the number of appropriate patients who actually receive potentially life saving therapy.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"438-42"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023161.35685.68","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the MADIT II criteria for implantable cardioverter defibrillators-what is the role of the Food and Drug Administration approval?","authors":"Helen S Barold","doi":"10.1023/B:CEPR.0000023166.65777.6f","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023166.65777.6f","url":null,"abstract":"<p><p>The results of the MADIT II study have generated a great deal of controversy in the world of electrophysiology. Much of the controversy appears related to the sheer numbers of potential Implantable Cardioverter Defibrillator (ICD) implants and their potential cost to the healthcare system. Two federal regulatory agencies, the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) have been highly visible in discussions. The FDA approved the MADIT II indications for Guidant ICDs, while CMS covered a limited subset of the patients studied. This review explores some the issues surrounding the trial and the key participants in this discussion with emphasis on the role of the Food and Drug Administration (FDA) and how regulatory decisions may impact on clinical practice.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"443-6"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023166.65777.6f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Defibrillator in Acute Myocardial Infarction Trial (DINAMIT): rationale, design and specific aims.","authors":"Gerian Grönefeld,&nbsp;Stuart J Connolly,&nbsp;Stefan H Hohnloser","doi":"10.1023/B:CEPR.0000023154.52786.f4","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023154.52786.f4","url":null,"abstract":"<p><p>The implantable defibrillator (ICD) effectively palliates arrhythmogenic events and thereby reduces total mortality in patients after a first episode of cardiac arrest. At present, four randomized controlled trials have addressed the issue of primary prevention by the ICD in patients with coronary artery disease and two small studies are available dealing with patients suffering from nonischemic cardiomyopathy. Importantly, none of the randomized studies in patients suffering from coronary artery disease has examined the potential role of the ICD in patients early after myocardial infarction. Within the next 12 months, important additional data is expected from several studies which have completed patient enrollment and follow-up. All studies are prospective randomized trials investigating the effects of ICD compared to optimal medical therapy. This paper summarizes the rationale, design and specific contributions of the Defibrillator in Myocardial infarction trial (DINAMIT) in comparison to other relevant studies on primary prevention of sudden cardiac death.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"447-51"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023154.52786.f4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amiodarone versus Implantable Defibrillator (AMIOVIRT): background, rationale, design, methods, results and implications.","authors":"Mevan Wijetunga,&nbsp;S Adam Strickberger","doi":"10.1023/B:CEPR.0000023158.52511.76","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023158.52511.76","url":null,"abstract":"<p><p>Non ischemic dilated cardiomyopathy (NIDCM) is a substrate for sudden cardiac death. Treatment with amiodarone may have a positive or neutral survival benefit. The role of ICD therapy in the primary prevention of sudden cardiac death in asymptomatic NIDCM patients is not clear. The purpose of the Amiodarone versus Implantable Defibrillator (AMIOVIRT) study was to compare total mortality, arrhythmia-free survival, quality of life and costs of therapy in patients with NIDCM, asymptomatic non-sustained ventricular tachycardia (NSVT) and left ventricular ejection fraction <or=0.35 who were randomized to therapy with amiodarone (52 patients) or an ICD (51 patients). At the first scheduled interim analysis, the previously determined stopping rule for futility was reached and the study was stopped. There was no statistically significant difference in the 1- and 3-year survival rates in the patients who received amiodarone compared with those who received an ICD (90% and 87% for amiodarone group versus 96% and 88% for ICD group; p = 0.8). There was a trend towards improved arrhythmia-free survival rates (p = 0.1), and cost of medical care (8,879 dollars vs. 22,039 dollars, p = 0.1) in the patients who were treated with amiodarone as compared to the patients who were treated with an ICD. At one year, the quality of life measures were not significantly different (p = 0.1).</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"452-6"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023158.52511.76","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of pacing mode after interruption of atrioventricular conduction for atrial fibrillation: observations from the PA3 clinical trial.","authors":"Anne M Gillis","doi":"10.1023/B:CEPR.0000023130.12304.e4","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023130.12304.e4","url":null,"abstract":"<p><p>The optimal pacing mode for patients with paroxysmal atrial fibrillation (AF) following AV junction ablation remains the subject of some debate. Recent clinical trials have not demonstrated a superior advantage of maintenance of sinus rhythm over the rate control approach. However, clinical trials in pacemaker populations have demonstrated that physiologic pacing reduces the probability of paroxysmal and persistent AF compared to ventricular pacing. In the second phase of the PA(3) study, patients were randomized to DDDR versus VDD pacing in a cross over study design. Of the 67 patients randomized, 42% developed permanent AF within one year following ablation. AF frequency and burden increases early following AV junction ablation suggesting that ventricular pacing even in an atrial synchronous mode promotes AF. Given the high probability of permanent AF developing early following ablation, VVIR pacing appears to be the appropriate pacing mode for symptomatic patients undergoing total AV junction ablation.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"312-4"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023130.12304.e4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}