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https://hdl.handle.net/2440/52204
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Type: | Journal article |
Title: | Pulmonary-vein isolation for atrial fibrillation in patients with heart failure |
Author: | Khan, M. Jais, P. Cummings, J. Di Biase, L. Sanders, P. Martin, D. Kautzner, J. Hao, S. Themistoclakis, S. Fanelli, R. Potenza, D. Massaro, R. Wazni, O. Schweikert, R. Saliba, W. Wang, P. Al-Ahmad, A. Beheiry, S. Santarelli, P. Starling, R. et al. |
Citation: | New England Journal of Medicine, 2008; 359(17):1778-1785 |
Publisher: | Massachusetts Medical Soc |
Issue Date: | 2008 |
ISSN: | 0028-4793 1533-4406 |
Statement of Responsibility: | Mohammed N. Khan,...Prashanthan Sanders, et al. |
Abstract: | <h4>Background</h4>Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.) |
Keywords: | PABA-CHF Investigators Pulmonary Veins Humans Atrial Fibrillation Postoperative Complications Anti-Arrhythmia Agents Stroke Volume Catheter Ablation Cardiac Pacing, Artificial Combined Modality Therapy Follow-Up Studies Physical Endurance Middle Aged Female Male |
DOI: | 10.1056/NEJMoa0708234 |
Published version: | http://dx.doi.org/10.1056/nejmoa0708234 |
Appears in Collections: | Aurora harvest 5 Medicine publications |
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