Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/52204
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Type: Journal article
Title: Pulmonary-vein isolation for atrial fibrillation in patients with heart failure
Author: Khan, M.
Jais, P.
Cummings, J.
Di Biase, L.
Sanders, P.
Martin, D.
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.
et al.
Citation: New England Journal of Medicine, 2008; 359(17):1778-1785
Publisher: Massachusetts Medical Soc
Issue Date: 2008
ISSN: 0028-4793
1533-4406
Statement of
Responsibility: 
Mohammed N. Khan,...Prashanthan Sanders, et al.
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 less, 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.)
Keywords: PABA-CHF Investigators; Pulmonary Veins; Humans; Atrial Fibrillation; Postoperative Complications; Anti-Arrhythmia Agents; Stroke Volume; Catheter Ablation; Cardiac Pacing, Artificial; Combined Modality Therapy; Follow-Up Studies; Physical Endurance; Middle Aged; Female; Male
RMID: 0020083061
DOI: 10.1056/NEJMoa0708234
Appears in Collections:Medicine publications

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