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Long-term symptom improvement and patient satisfaction after AV-node ablation vs. pulmonary vein isolation for symptomatic atrial fibrillation: results from the German Ablation Registry

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Abstract

Background

We aimed to compare patient characteristics and outcome of patients who had either undergone pulmonary vein isolation (PVI) or AV-node ablation (AVN) to control AF-related symptoms.

Methods

From the German Ablation Registry, we analyzed data of 4444 patients (95%) who had undergone PVI and 234 patients (5%) with AVN.

Results

AVN patients were on average 10 years older than PVI patients (71 ± 10 vs. 61 ± 10 years, p < 0.001) with 33% aged > 75 years. AVN patients had significantly more cardiovascular comorbidities (diabetes 21% vs. 8%, renal insufficiency 24% vs. 3%, underlying heart disease 80% vs. 36%, severely reduced left ventricular function 28% vs. 1%, all p < 0.001). Significantly more PVI patients had paroxysmal AF (63% vs. 18%, p < 0.001), and more AVN patients had long-standing persistent AF (44% vs. 7%, p < 0.001). At 1-year follow-up, mortality in the AVN group was much higher (Kaplan–Meier estimates 9.8% vs. 0.5%). 20% of PVI patients had undergone another ablation vs. 3% AVN patients (p < 0.001). Symptomatic improvement was equally achieved in about 80%. Re-hospitalization for cardiovascular reasons occurred significantly more often in PVI vs. AVN patients (31% vs. 18%, p < 0.001).

Conclusion

In the large German Ablation Registry, AVN ablation was performed much less frequently than PVI for symptomatic treatment of AF and typically in older patients with more comorbidity. Symptomatic improvement was similar in both groups. Hospitalizations for cardiovascular reasons were lower in AVN patients despite older age and more cardiovascular comorbidities. 20% of PVI patients had undergone at least one re-ablation.

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Funding

The work was supported by an unrestricted grant from foundation ‘Stiftung Institut für Herzinfarktforschung Ludwigshafen’ (IHF, Ludwigshafen, Germany) and minor unrestricted grants from Medtronic, Biosense Webster, and Biotronik.

Author information

Authors and Affiliations

  1. Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Kristina Wasmer & L. Eckardt

  2. Stiftung Institut für Herzinfarktforschung (IHF), Ludwigshafen am Rhein, Germany

    M. Hochadel & J. Senges

  3. Elisabeth-Krankenhaus Essen, Essen, Germany

    H. Wieneke

  4. Praxisklinik Herz und Gefaesse, Dresden, Germany

    S. G. Spitzer

  5. Brandenburg University of Technology Cottbus-Senftenberg, Cottbus-Senftenberg, Germany

    S. G. Spitzer

  6. Department of Cardiology, Angiology, and Pneumology, Second Medical Clinic, Coburg Hospital, Coburg, Germany

    J. Brachmann

  7. Munich Municipal Hospital Group, Heart Center Munich-Bogenhausen, Munich, Germany

    F. Straube

  8. Klinikum Hildesheim, Hildesheim, Germany

    J. Tebbenjohanns

  9. Klinikum Aschaffenburg, Aschaffenburg, Germany

    G. Groschup

  10. Klinikum Wilhelmshaven, Wilhelmshaven, Germany

    A. Heisel

  11. Department of Medicine-Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany

    T. Lewalter

Authors
  1. Kristina Wasmer
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  2. M. Hochadel
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  3. H. Wieneke
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  4. S. G. Spitzer
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  5. J. Brachmann
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  8. G. Groschup
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  9. A. Heisel
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  10. T. Lewalter
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  11. J. Senges
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  12. L. Eckardt
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Corresponding author

Correspondence to Kristina Wasmer.

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Wasmer, K., Hochadel, M., Wieneke, H. et al. Long-term symptom improvement and patient satisfaction after AV-node ablation vs. pulmonary vein isolation for symptomatic atrial fibrillation: results from the German Ablation Registry. Clin Res Cardiol 108, 395–401 (2019). https://doi.org/10.1007/s00392-018-1368-2

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  • DOI: https://doi.org/10.1007/s00392-018-1368-2

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