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document
Biventricular pacing improves cardiac function and prevents further left atrial remodeling in patients with symptomatic atrial fibrillation after atrioventricular node ablation . BACKGROUND Randomized trials have demonstrated benefits of biventricular ( BiV ) pacing in patients with advanced heart failure , intraventricular conduction delay , and atrial fibrillation ( AF ) post-atrioventricular ( AV ) node ablation . The AV Node Ablation with CLS and CRT Pacing Therapies for Treatment of AF trial ( AVAIL CLS/CRT ) was designed to demonstrate superiority of BiV pacing in patients with AF after AV node ablation , to evaluate its effects on cardiac structure and function , and to investigate additional benefits of Closed Loop Stimulation ( CLS ) ( BIOTRONIK , Berlin , Germany ) . METHODS Patients with refractory AF underwent AV node ablation and were randomized ( 2:2:1 ) to BiV pacing with CLS , BiV pacing with accelerometer , or right ventricular ( RV ) pacing . Echocardiography was performed at baseline and 6 months , with paired data available for 108 patients . RESULTS The RV pacing contributed to significant increase in left atrial volume , left ventricular ( LV ) end-systolic volume , and LV mass compared to BiV pacing . Ejection fraction decreased insignificantly with RV pacing compared to significant increase with BiV pacing . Interventricular dyssynchrony significantly decreased with BiV compared with RV pacing . Closed Loop Stimulation did not result in additional echocardiographic changes ; heart rate distribution was significantly wider with CLS . All groups showed significant improvement in 6-minute walk distance , quality-of-life score , and New York Heart Association class . CONCLUSION In conclusion , RV pacing results in significant increase in left atrial volume , LV mass , and worsening of LV contractility compared to patients receiving BiV pacing post-AV node ablation for refractory AF . Closed Loop Stimulation was not associated with additional structural changes but resulted in significantly wider heart rate distribution .
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Intervention_Physical
biventricular ( BiV ) pacing
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Intervention_Physical
BiV pacing with CLS , BiV pacing with accelerometer , or right ventricular ( RV ) pacing
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Outcome_Physical
cardiac function
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Outcome_Physical
left atrial remodeling
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Outcome_Physical
left atrial volume , left ventricular ( LV ) end-systolic volume , and LV mass
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Outcome_Physical
Ejection fraction
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Outcome_Physical
Interventricular dyssynchrony
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Outcome_Physical
echocardiographic changes
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Outcome_Physical
heart rate distribution
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Outcome_Physical
6-minute walk distance
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Outcome_Other
quality-of-life score
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Outcome_Other
New York Heart Association class
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Outcome_Physical
left atrial volume
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Outcome_Physical
worsening of LV contractility
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Outcome_Physical
structural changes
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Outcome_Physical
wider heart rate distribution
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Participant_Condition
symptomatic atrial fibrillation
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Participant_Condition
advanced heart failure
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Participant_Condition
intraventricular conduction delay ,
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Participant_Condition
atrial fibrillation ( AF ) post-atrioventricular ( AV ) node ablation
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Participant_Condition
AF
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Participant_Sample-size
108