Atrioventricular node ablation and pacing for atrial tachyarrhythmias: A meta-analysis of postoperative outcomes.

Abstract

BACKGROUND:

Atrioventricular node ablation (AVNA) and pacemaker (PM) is performed in symptomatic atrial fibrillation (AF) unresponsive to medical treatment and percutaneous ablation. This meta-analysis evaluated results after AVNA and PM.

METHODS:

Primary and secondary endpoints were early/late overall/cardiac-related mortality and early/late postoperative complications. Meta-regression explored mortality and preoperative characteristics relation.

RESULTS:

We selected 93 studies with 11,340 patients: 9105 right ventricular (RV)-PM, and 2235 biventricular PM (cardiac resynchronization therapy, CRT). Malignant arrhythmia (2.5%), heart failure (2.4%), and lead dislodgement (2.0%) were most common periprocedural complications. Pooled estimated 30-day mortality was 1.08% (95%CI:0.65-1.77). At 19.9 months median follow-up (IQR: 10.3-34 months), rehospitalization (0.79%/month) and heart failure (0.48%/month) were the most frequent complications. Overall mortality incidence rate (IR) was 0.43%/month (95%CI:0.36-0.51), and cardiac death IR 0.27%/month (95%CI:0.22-0.32). No mortality determinants emerged in the AVNA CRT subgroup. AVNA RV-PM subgroup univariable meta-regression showed inverse relationship between age, ejection fraction (EF), and late cardiac death (Beta = -0.0709 ± 0.0272; p = 0.0092 and Beta = -0.0833 ± 0.0249; p = 0.0008). Coronary artery disease (CAD) was directly associated to follow-up overall/cardiac mortality at univariable (Beta = 0.0550 ± 0.0136, p < 0.0001; Beta = 0.0540 ± 0.0130, p < 0.0001) and multivariable (Beta = 0.0460 ± 0.0189, p = 0.152; Beta = 0.0378 ± 0.0192, p = 0.0491) meta-regression.

CONCLUSIONS:

Solid long-term evidence supporting AVNA and pace is lacking. Younger patients with reduced LVEF% have increased follow-up cardiac mortality after AVNA RV and may require CRT. Alternative strategies to maintain sinus rhythm and ventricular synchronism should be compared to AVNA to support future treatment strategies.

• Authors: Massimo Baudo, Giuseppe D'Ancona, Francesco Trinca, Fabrizio Rosati, Lorenzo Di Bacco, Antonio Curnis, Claudio Muneretto, Marco Metra, Stefano Benussi
• Journal: International journal of cardiology (Int J Cardiol) Vol. 363 Pg. 80-86 (09 15 2022) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 35764203 (Publication Type: Journal Article, Meta-Analysis, Review)
• Copyright: Copyright © 2022 Elsevier B.V. All rights reserved.

Topics

• Atrial Fibrillation (diagnosis, surgery)
• Atrioventricular Node (surgery)
• Cardiac Resynchronization Therapy (methods)
• Catheter Ablation (adverse effects, methods)
• Death
• Heart Failure
• Humans
• Tachycardia
• Treatment Outcome