Ventricular pacing vs dual chamber pacing in patients with persistent atrial fibrillation after atrioventricular node ablation: open randomized study.

Aim: To compare ventricular rate responsive (VVIR) pacing with dual chamber rate responsive (DDDR) pacing and antiarrhythmic drugs for the treatment of patients with persistent atrial fibrillation after atrioventricular node ablation.

Methods: One hundred two patients with persistent atrial fibrillation eligible for the atrioventricular node ablation were randomly assigned to the therapy with either VVIR pacemaker (n=52) or DDDR pacemaker and antiarrhythmic drugs (n=50). After ablation, patients in both pacing groups were assigned to take anticoagulant therapy. The primary end point was stroke or death from cardiovascular causes.

Results: After a mean follow-up of 26.6+/-9.5 months, there was no difference in the stroke or death rates between patients with VVIR pacing (6 or 5.2% per year) and those with DDDR pacing and antiarrhythmic drugs (6 or 5.9% per year, P=0.930). The observed rates of death from all causes, hospitalization for heart failure, and myocardial ischemia were similar in the two patient groups. There was a significantly lower rate of development of permanent atrial fibrillation in patients with DDDR pacing and antiarrhythmic drugs, with a reduction in absolute risk by 56% and relative risk by 64% (32% vs 88%; P<0.001).

Conclusion: With respect to cardiovascular death and morbidity, VVIR pacing is not inferior to DDDR pacing and antiarrhythmic drugs for the treatment of patients with persistent atrial fibrillation after atrioventricular node ablation and may be considered as an appropriate therapy for such patients.