Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation.

OBJECTIVE To assess long term mortality and identify factors associated with the development of permanent atrial fibrillation after atrioventricular (AV) node ablation for drug refractory paroxysmal atrial fibrillation. DESIGN Retrospective cohort study. SETTING UK tertiary centre teaching hospital. PATIENTS Patients admitted to the University Hospital Birmingham between January 1995 and December 2000. INTERVENTIONS AV node ablation and dual chamber mode switching pacing. MAIN OUTCOME MEASURES Long term mortality and predictors of permanent atrial fibrillation, assessed through Kaplan-Meier curves and logistic regression. RESULTS 114 patients (1995-2000) were included: age (mean (SD)), 65 (9) years; 55 (48%) male; left atrial diameter 4 (1) cm; left ventricular end diastolic diameter 5 (1) cm; ejection fraction 54 (17)%. Indications for AV node ablation were paroxysmal atrial fibrillation in 95 (83%) and paroxysmal atrial fibrillation/flutter in 19 (17%). The survival curve showed a low overall mortality after 72 months (10.5%). Fifty two per cent of patients progressed to permanent atrial fibrillation within 72 months. There was no difference in progression to permanency between paroxysmal atrial fibrillation and paroxysmal atrial fibrillation/flutter (log rank 0.06, p = 0.8). Logistic regression did not show any association between the variables collected and the development of permanent atrial fibrillation, although age over 80 years showed a trend (p = 0.07). CONCLUSIONS Ablate and pace is associated with a low overall mortality. No predictors of permanent atrial fibrillation were identified, but 48% of patients were still in sinus rhythm at 72 months. These results support the use of dual chamber pacing for paroxysmal atrial fibrillation patients after ablate and pace.