Long-term outcomes after radiofrequency catheter ablation of the atrioventricular node: The experience of a Portuguese tertiary center

• Published in: Revista portuguesa de cardiologia (English ed.) 2021-02, Vol.40 (2), p.95-103
• Main Authors: Manuel, Ana Mosalina, Almeida, João, Fonseca, Paulo, Monteiro, Joel, Guerreiro, Cláudio, Barbosa, Ana Raquel, Teixeira, Pedro, Ribeiro, José, Santos, Elisabeth, Rosas, Filipa, Dias, Adelaide, Caeiro, Daniel, Sousa, Olga, Teixeira, Madalena, Oliveira, Marco, Gonçalves, Helena, Primo, João, Braga, Pedro
• Format: Article
• Language: English
• Subjects: Ablação do nódulo auriculoventricular; Atrioventricular node ablation; Disritmias supraventriculares; Heart failure; Insuficiência cardíaca; Supraventricular arrhythmias
• ISSN: 2174-2049; 2174-2049
• DOI: 10.1016/j.repce.2020.05.025

In patients with supraventricular arrhythmias and high ventricular rate, unresponsive to rate and rhythm control therapy or catheter ablation, atrioventricular (AV) node ablation may be performed. To assess long-term outcomes after AV node ablation and to analyze predictors of adverse events. We performed a detailed retrospective analysis of all patients who underwent AV node ablation between February 1997 and February 2019, in a single Portuguese tertiary center. A total of 123 patients, mean age 69±9 years and 52% male, underwent AV node ablation. Most of them presented atrial fibrillation at baseline (65%). During a median follow-up of 8.5 years (interquartile range 3.8-11.8), patients improved heart failure (HF) functional class (NYHA class III-IV 46% versus 13%, p=0.001), and there were reductions in hospitalizations due to HF (0.98±1.3 versus 0.28±0.8, p=0.001) and emergency department (ED) visits (1.1±1 versus 0.17±0.7, p=0.0001). There were no device-related complications. Despite permanent pacemaker stimulation, left ventricular ejection fraction did not worsen (47±13% vs. 47%±12, p=0.63). Twenty-eight patients died (23%). The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome (OR 1.8, 95% CI 1.24-2.61, p=0.002). Despite pacemaker dependency, the clinical benefit of AV node ablation persisted at long-term follow-up. The number of ED visits due to HF before AV node ablation was an independent predictor of the composite adverse outcome. AV node ablation should probably be considered earlier in the treatment of patients with supraventricular arrhythmias and HF, especially in cases that are unsuitable for selective ablation of the specific arrhythmia. Nos doentes com disritmias supraventriculares e frequência ventricular elevada, irresponsivos à terapêutica para controlo da frequência e do ritmo, ou à ablação por catéter, a ablação do nódulo auriculoventricular (ANAV) pode ser realizada. Avaliar os resultados em longo prazo após a ANAV e analisar preditores de eventos adversos. Análise retrospetiva detalhada, dos doentes submetidos à ANAV entre fevereiro 1997 e fevereiro 2019, num centro terciário português. Foram submetidos 123 doentes à ANAV: idade média 69 ± 9 anos e 52% homens. A maioria apresentou fibrilhação auricular (65%). Num período mediano de seguimento de 8,5 anos (intervalo interquartil 3,8-11,8), houve melhoria da classe funcional de insuficiência cardíaca (IC) (classe NYHA