Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation : Effects of pacing mode and mode-switch algorithm
Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated. Symptom...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1999-03, Vol.99 (12), p.1587-1592 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | MARSHALL, H. J HARRIS, Z. I GRIFFITH, M. J HOLDER, R. L GAMMAGE, M. D |
| description | Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.
Symptomatic patients who had tried >/=2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P |
| doi_str_mv | 10.1161/01.CIR.99.12.1587 |
| format | Article |
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Symptomatic patients who had tried >/=2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P<0.01), palpitations (-58%, P=0. 0001), and dyspnea (-37%, P<0.05). Changes in score from baseline were better with ablation and DDDR/MS pacing for overall symptoms (-48% versus -4%, P<0.005), palpitation (-62% versus -5%, P<0.001), dyspnea (-44% versus -3%, P<0.005), and PGWB (+12% versus +0.5%, P<0. 05). DDDR/MS was better than VVIR pacing for overall symptoms (-21%, P<0.05), dyspnea (-30%, P<0.005), and MHI (+5%, P<0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19, P<0.01).
Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.]]></description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.99.12.1587</identifier><identifier>PMID: 10096935</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Algorithms ; Anti-Arrhythmia Agents - therapeutic use ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiac Pacing, Artificial - methods ; Cardiology. Vascular system ; Catheter Ablation ; Female ; Heart ; Humans ; Male ; Medical sciences ; Middle Aged ; Prospective Studies ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 1999-03, Vol.99 (12), p.1587-1592</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Mar 30, 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c395t-a9a4bba9380c2d8372271bc4072def287916b2890668a06a8e04691e58733b073</citedby><cites>FETCH-LOGICAL-c395t-a9a4bba9380c2d8372271bc4072def287916b2890668a06a8e04691e58733b073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1721182$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10096935$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MARSHALL, H. J</creatorcontrib><creatorcontrib>HARRIS, Z. I</creatorcontrib><creatorcontrib>GRIFFITH, M. J</creatorcontrib><creatorcontrib>HOLDER, R. L</creatorcontrib><creatorcontrib>GAMMAGE, M. D</creatorcontrib><title>Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation : Effects of pacing mode and mode-switch algorithm</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description><![CDATA[Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.
Symptomatic patients who had tried >/=2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P<0.01), palpitations (-58%, P=0. 0001), and dyspnea (-37%, P<0.05). Changes in score from baseline were better with ablation and DDDR/MS pacing for overall symptoms (-48% versus -4%, P<0.005), palpitation (-62% versus -5%, P<0.001), dyspnea (-44% versus -3%, P<0.005), and PGWB (+12% versus +0.5%, P<0. 05). DDDR/MS was better than VVIR pacing for overall symptoms (-21%, P<0.05), dyspnea (-30%, P<0.005), and MHI (+5%, P<0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19, P<0.01).
Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.]]></description><subject>Aged</subject><subject>Algorithms</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiology. Vascular system</subject><subject>Catheter Ablation</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkdGK1DAUhoMo7jj6AN5IEPGuNSdpk8a7ZVh1YUERvQ5pmu5kaZsxaVfHp_FRPeMUFK9OkvOdP4f_J-Q5sBJAwhsG5e76c6l1CbyEulEPyAZqXhVVLfRDsmGM6UIJzi_Ik5zv8CqFqh-TC8CG1KLekF-fUswH7-Zw72myUxfH8NN3NM9Ld6Sxp7Yd7BziRLFHD9aF6Zbe-5SXTEffBWcHOu99socj7WNCIsUfxzzis51TwNKHNoVhFXlLr_oef8sn6VVtjJ3_o346FPl7mN2e2uE2pjDvx6fkUW-H7J-tdUu-vrv6svtQ3Hx8f727vCmc0PVcWG2rtrVaNMzxrhGKcwWtq5jine95ozTIljeaSdlYJm3jWSU1eDRNiJYpsSWvz7qHFL8tPs9mDNl5XHzycclGalkrWWsEX_4H3sUlTbib4cClrAS6vCVwhhzam5PvzSGF0aajAWZO2RkGBrMzWhvg5pQdzrxYhZcWrf1n4hwWAq9WwGb0vce4XMh_OcUBGi5-A0Eyo3M</recordid><startdate>19990330</startdate><enddate>19990330</enddate><creator>MARSHALL, H. J</creator><creator>HARRIS, Z. I</creator><creator>GRIFFITH, M. J</creator><creator>HOLDER, R. L</creator><creator>GAMMAGE, M. D</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>19990330</creationdate><title>Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation : Effects of pacing mode and mode-switch algorithm</title><author>MARSHALL, H. J ; HARRIS, Z. I ; GRIFFITH, M. J ; HOLDER, R. L ; GAMMAGE, M. D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c395t-a9a4bba9380c2d8372271bc4072def287916b2890668a06a8e04691e58733b073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Algorithms</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Atrial Fibrillation - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiology. Vascular system</topic><topic>Catheter Ablation</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MARSHALL, H. J</creatorcontrib><creatorcontrib>HARRIS, Z. I</creatorcontrib><creatorcontrib>GRIFFITH, M. J</creatorcontrib><creatorcontrib>HOLDER, R. L</creatorcontrib><creatorcontrib>GAMMAGE, M. D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MARSHALL, H. J</au><au>HARRIS, Z. I</au><au>GRIFFITH, M. J</au><au>HOLDER, R. L</au><au>GAMMAGE, M. D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation : Effects of pacing mode and mode-switch algorithm</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>1999-03-30</date><risdate>1999</risdate><volume>99</volume><issue>12</issue><spage>1587</spage><epage>1592</epage><pages>1587-1592</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract><![CDATA[Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.
Symptomatic patients who had tried >/=2 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR/MS or VVIR and subsequently crossed over. Ablation and DDDR/MS pacing produced better scores than drug therapy for overall symptoms (-41%, P<0.01), palpitations (-58%, P=0. 0001), and dyspnea (-37%, P<0.05). Changes in score from baseline were better with ablation and DDDR/MS pacing for overall symptoms (-48% versus -4%, P<0.005), palpitation (-62% versus -5%, P<0.001), dyspnea (-44% versus -3%, P<0.005), and PGWB (+12% versus +0.5%, P<0. 05). DDDR/MS was better than VVIR pacing for overall symptoms (-21%, P<0.05), dyspnea (-30%, P<0.005), and MHI (+5%, P<0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19, P<0.01).
Ablation and DDDR/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.]]></abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>10096935</pmid><doi>10.1161/01.CIR.99.12.1587</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Algorithms Anti-Arrhythmia Agents - therapeutic use Atrial Fibrillation - therapy Biological and medical sciences Cardiac dysrhythmias Cardiac Pacing, Artificial - methods Cardiology. Vascular system Catheter Ablation Female Heart Humans Male Medical sciences Middle Aged Prospective Studies Treatment Outcome |
| title | Prospective randomized study of ablation and pacing versus medical therapy for paroxysmal atrial fibrillation : Effects of pacing mode and mode-switch algorithm |
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