Evaluation of pacemaker dependence in patients on ablate and pace therapy for atrial fibrillation

In patients with atrial fibrillation (AF) and uncontrolled ventricular rate, radiofrequency (RF) ablation of the atrioventricular (AV) node and pacemaker (PM) implantation (ablate and pace) is a valid therapeutic approach, especially in elderly patients. The aim of our study was to evaluate the PM dependence and the incidence of correlated clinical phenomena in a patients population with AV block induced by RF ablation of the AV junction.

One-hundred and sixty-three patients (71 men; mean age 71 +/- 8 years) who had undergone ablate and pace therapy were evaluated. The patients underwent assessment of quality of life, impairment of consciousness, stroke/transient ischaemic attack (TIA), hospitalizations for heart failure, episodes of palpitations, and instrumental evaluation of PM dependence during PM inhibition (absence of escape rhythm; asystolic pause >5 s; escape rhythm <30 bpm after rhythm stabilization). Correlation between instrumentally evaluated PM dependence and clinical history was analysed. Hundred and thirty-two patients were evaluated after a mean follow-up period of 36 months [31 subjects (19%) died before the evaluation]; 55 patients (42%) were classified as PM-dependent: 38 (69%) complained of disturbances (19 dizziness, 15 pre-syncope, 4 syncope); 77 patients (58%) were considered non-PM-dependent: symptoms (dizziness, flush) were reported by only 3 (4%). No significant differences emerged between PM-dependent and non-PM-dependent patients with regard to episodes of pre-syncope, syncope, stroke/TIA, hospitalizations for heart failure, and quality of life.

This study confirms that ablate and pace is an effective and safe approach in subjects with chronic or recurrent AF and uncontrolled ventricular rate.