Pulmonary-vein isolation for atrial fibrillation in patients with heart failure
Anno:
2008
Rivista: NEW ENGLAND JOURNAL OF MEDICINE
Autori/autrici: Khan, M. N.; Jais, P.; Cummings, J.; Di Biase, L.; Sanders, P.; Martin, D. O.; 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. C.; Dello Russo, A.; Pelargonio, G.; Brachmann, J.; Schibgilla, V.; Bonso, A.; Casella, M.; Raviele, A.; Haissaguerre, M.; Natale, A.
Lingua: ENG
Classificazione IRIS: 1.1 Articolo in rivista
Scheda completa IRIS: https://iris.univpm.it/handle/11566/275028
Citazioni:Pulmonary-vein isolation for atrial fibrillation in patients with heart failure / Khan, M.N., Jais, P., Cummings, J., Di Biase, L., Sanders, P., Martin, D.O., 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.C., et al.. - In: THE NEW ENGLAND JOURNAL OF MEDICINE. - ISSN 0028-4793. - 359:17(2008), pp. 1778-1785. [10.1056/NEJMoa0708234]
Abstract:Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or le
...ss, 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. Results: 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. Conclusions: 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.) Copyright © 2008 Massachusetts Medical Society. All rights reserved.
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