Atrioventricular Nodal Ablation in Atrial Fibrillation: A Meta-Analysis and Systematic Review

Study Questions:

How efficacious is atrioventricular node ablation (AVNA) in patients with atrial fibrillation (AF)?

Methods:

This was a meta-analysis of five studies (314 patients) that compared AVNA to pharmacological therapy, along with a summary of 11 observational studies (810 patients) that assessed the effectiveness of AVNA and 47 studies (5,632 patients) that assessed safety.

Results:

In the meta-analysis, there were no significant differences in mortality or exercise duration between AVNA and drug therapy. AVNA had no effect on left ventricular ejection fraction (LVEF) in patients without LV dysfunction, and was associated with a significant increase in mean LVEF from a baseline of 44% to 48% in patients with LV dysfunction. The observational studies demonstrated a 2.9% redo rate because of recurrent AVN conduction, an increase in LVEF of 4.8%, and an increase in exercise duration of 1.2 minutes after AVNA. In the randomized and observational studies, AVNA resulted in an improvement in symptoms and quality-of-life measures. The procedure-related death rate was 0.3%. Other complications consisted of hematoma (0.7%), malignant arrhythmias (0.6%), pacemaker lead failure (0.2%), and stroke (0.2%). The incidence of sudden death at a mean follow-up of 26 months was 2.1%.

Conclusions:

AVNA is associated with an improvement in symptoms and quality of life and a modest increase in LVEF in patients with abnormal LV function.

Perspective:

AVNA can have dramatic beneficial effects in patients with persistent AF and inadequate rate control despite pharmacological therapy. Many of the studies used in this meta-analysis/summary included patients with adequate rate control, thereby underestimating the potential benefits of AVNA in patients with tachycardia-induced cardiomyopathy.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Stroke, Follow-Up Studies, Ventricular Function, Left, Killer Cells, Natural, Hematoma, Tachycardia, Incidence, Cardiomyopathies, Heart Failure, Stroke Volume, Pacemaker, Artificial, Catheter Ablation, Death, Sudden, Cardiac, Atrioventricular Node


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