Biomaterial Database

Atrioventricular nodal ablation and pacemaker implantation in patients with atrial fibrillation. 1999

P Touboul

Hôpital Cardiologique, Lyons, France.

In drug-resistant, poorly tolerated atrial fibrillation, atrioventricular (AV) junction catheter ablation can be proposed as the last-resort option. Technically, the procedure is easy to perform and relatively safe. Interruption of the AV conduction implies the insertion of a permanent pacemaker. In patients with chronic atrial fibrillation, a VVIR pacemaker is inserted. For those having severely symptomatic episodes of paroxysmal atrial fibrillation, DDDR mode-switching devices are more appropriate. Results are remarkable. The treatment is highly effective in controlling symptoms and improving general well-being. Exercise capacity is also increased. Left ventricular ejection fraction may increase after ablation, an effect that is mainly apparent in patients with markedly depressed myocardial function. Consumption of healthcare resources has been shown to decrease significantly in the aftermath of AV junction ablation. However, sudden-death risk has been invoked as a limiting factor for the procedure. This may be due to AV-block-related ventricular tachyarrhythmias, occurring early after ablation, whereas the reasons for late sudden deaths are somewhat more obscure. It is unclear whether such events are procedure-related or rather secondary to the underlying heart disease. Thus, AV junction ablation for refractory atrial fibrillation remains the only nonpharmacologic, alternative therapy that is performed on a routine basis. Failure of newer therapeutic approaches should further reinforce the clinical impact of this procedure in the future.

UI	MeSH Term	Description	Entries
D010138	Pacemaker, Artificial	A device designed to stimulate, by electric impulses, contraction of the heart muscles. It may be temporary (external) or permanent (internal or internal-external).	Cardiac Pacemaker, Artificial,Artificial Cardiac Pacemaker,Artificial Cardiac Pacemakers,Artificial Pacemaker,Artificial Pacemakers,Cardiac Pacemakers, Artificial,Pacemaker, Artificial Cardiac,Pacemakers, Artificial,Pacemakers, Artificial Cardiac
D003131	Combined Modality Therapy	The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used.	Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001281	Atrial Fibrillation	Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation.	Auricular Fibrillation,Familial Atrial Fibrillation,Paroxysmal Atrial Fibrillation,Persistent Atrial Fibrillation,Atrial Fibrillation, Familial,Atrial Fibrillation, Paroxysmal,Atrial Fibrillation, Persistent,Atrial Fibrillations,Atrial Fibrillations, Familial,Atrial Fibrillations, Paroxysmal,Atrial Fibrillations, Persistent,Auricular Fibrillations,Familial Atrial Fibrillations,Fibrillation, Atrial,Fibrillation, Auricular,Fibrillation, Familial Atrial,Fibrillation, Paroxysmal Atrial,Fibrillation, Persistent Atrial,Fibrillations, Atrial,Fibrillations, Auricular,Fibrillations, Familial Atrial,Fibrillations, Paroxysmal Atrial,Fibrillations, Persistent Atrial,Paroxysmal Atrial Fibrillations,Persistent Atrial Fibrillations
D001283	Atrioventricular Node	A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart.	AV Node,A-V Node,Atrio-Ventricular Node,A V Node,A-V Nodes,AV Nodes,Atrio Ventricular Node,Atrio-Ventricular Nodes,Atrioventricular Nodes,Node, A-V,Node, AV,Node, Atrio-Ventricular,Node, Atrioventricular,Nodes, A-V,Nodes, AV,Nodes, Atrio-Ventricular,Nodes, Atrioventricular
D012307	Risk Factors	An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent.	Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D016757	Death, Sudden, Cardiac	Unexpected rapid natural death due to cardiovascular collapse within one hour of initial symptoms. It is usually caused by the worsening of existing heart diseases. The sudden onset of symptoms, such as CHEST PAIN and CARDIAC ARRHYTHMIAS, particularly VENTRICULAR TACHYCARDIA, can lead to the loss of consciousness and cardiac arrest followed by biological death. (from Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005)	Cardiac Sudden Death,Sudden Cardiac Death,Cardiac Arrest, Sudden,Sudden Cardiac Arrest,Arrest, Sudden Cardiac,Cardiac Arrests, Sudden,Cardiac Death, Sudden,Death, Cardiac Sudden,Death, Sudden Cardiac,Sudden Death, Cardiac
D016896	Treatment Outcome	Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.	Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017115	Catheter Ablation	Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias.	Ablation, Transvenous Electric,Catheter Ablation, Electric,Catheter Ablation, Percutaneous,Catheter Ablation, Radiofrequency,Catheter Ablation, Transvenous,Ablation, Catheter,Ablation, Transvenous Electrical,Catheter Ablation, Electrical,Electric Catheter Ablation,Electrical Catheter Ablation,Percutaneous Catheter Ablation,Radiofrequency Catheter Ablation,Transvenous Catheter Ablation,Ablation, Electric Catheter,Ablation, Electrical Catheter,Ablation, Percutaneous Catheter,Ablation, Radiofrequency Catheter,Ablation, Transvenous Catheter,Electric Ablation, Transvenous,Electrical Ablation, Transvenous,Transvenous Electric Ablation,Transvenous Electrical Ablation