Long-term survival following radiofrequency catheter ablation of atrioventricular junction for atrial fibrillation: clinical and ablation determinants of mortality.

BACKGROUND: For patients with drug-refractory atrial fibrillation, radiofrequency catheter ablation of the atrioventricular junction and pacemaker implantation is a nonpharmacologic option routinely used nowadays. Few data are available on the long-term survival following the procedure or on evaluation of the risk factors for death in a large study cohort.
METHODS: The patient population included 359 subjects undergoing atrioventricular junction ablation and pacemaker insertion. Fourteen clinical and 9 ablation variables were collected at baseline. During a mean following-up of 40.8 +/- 25.6 months, 46 patients died. Survival probability was estimated by the Kaplan-Meier methods. Multivariate Cox proportional hazards regression analysis was applied to define predictors of death.
RESULTS: Mean age was 64.6 +/- 10.6 years with 203 male (57.7%). Actuarial survival probability for the total patients was 0.953 and 0.827 at 1 and 5 year. Four clinical variables, but no ablation variables, were found to be independent predictors of death: age > or =65 year (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.00-3.69), the presence of heart failure (HR, 3.83; 95% CI, 1.87-7.86), coexisting diabetes (HR, 2.91; 95% CI, 1.47-5.77), and the value of fractional shortening < or =20% (HR, 5.79, 95% CI, 3.00-11.18). There were 20 deaths in 28 patients with > or =3 risk factors and 4 deaths in 115 patients with no risk factor.
CONCLUSION: The risk of death in patients undergoing ablation and pacing can be identified by readily available clinical variables. Patients with multiple risk factors are associated with an increasing mortality.