Pulmonary-vein isolation for atrial fibrillation in patients with heart failure

Mohammed N. Khan, Pierre Jaïs, Jennifer Cummings, Luigi Di Biase, Prashanthan Sanders, David O. Martin, Josef Kautzner, Steven Hao, Sakis Themistoclakis, Raffaele Fanelli, Domenico Potenza, Raimondo Massaro, Oussama Wazni, Robert Schweikert, Walid Saliba, Paul Wang, Amin Al-Ahmad, Salwa Beheiry, Pietro Santarelli, Randall C. Starling & 9 others Antonio Dello Russo, Gemma Pelargonio, Johannes Brachmann, Volker Schibgilla, Aldo Bonso, Michela Casella, Antonio Raviele, Michel Haïssaguerre, Andrea Natale

Research output: Contribution to journalArticle

425 Citations (Scopus)

Abstract

Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)

LanguageEnglish
Pages1778-1785
Number of pages8
JournalNew England Journal of Medicine
Volume359
Issue number17
DOIs
Publication statusPublished - 23 Oct 2008

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Khan, M. N., Jaïs, P., Cummings, J., Di Biase, L., Sanders, P., Martin, D. O., ... Natale, A. (2008). Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. New England Journal of Medicine, 359(17), 1778-1785. https://doi.org/10.1056/NEJMoa0708234
Khan, Mohammed N. ; Jaïs, Pierre ; Cummings, Jennifer ; Di Biase, Luigi ; Sanders, Prashanthan ; Martin, David O. ; Kautzner, Josef ; Hao, Steven ; Themistoclakis, Sakis ; Fanelli, Raffaele ; Potenza, Domenico ; Massaro, Raimondo ; Wazni, Oussama ; Schweikert, Robert ; Saliba, Walid ; Wang, Paul ; Al-Ahmad, Amin ; Beheiry, Salwa ; Santarelli, Pietro ; Starling, Randall C. ; Dello Russo, Antonio ; Pelargonio, Gemma ; Brachmann, Johannes ; Schibgilla, Volker ; Bonso, Aldo ; Casella, Michela ; Raviele, Antonio ; Haïssaguerre, Michel ; Natale, Andrea. / Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. In: New England Journal of Medicine. 2008 ; Vol. 359, No. 17. pp. 1778-1785.
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abstract = "Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40{\%} or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35{\%} vs. 28{\%}, P<0.001). In the group that underwent pulmonary-vein isolation, 88{\%} of patients receiving antiarrhythmic drugs and 71{\%} of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)",
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Khan, MN, Jaïs, P, Cummings, J, Di Biase, L, Sanders, P, Martin, DO, Kautzner, J, Hao, S, Themistoclakis, S, Fanelli, R, Potenza, D, Massaro, R, Wazni, O, Schweikert, R, Saliba, W, Wang, P, Al-Ahmad, A, Beheiry, S, Santarelli, P, Starling, RC, Dello Russo, A, Pelargonio, G, Brachmann, J, Schibgilla, V, Bonso, A, Casella, M, Raviele, A, Haïssaguerre, M & Natale, A 2008, 'Pulmonary-vein isolation for atrial fibrillation in patients with heart failure', New England Journal of Medicine, vol. 359, no. 17, pp. 1778-1785. https://doi.org/10.1056/NEJMoa0708234

Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. / Khan, Mohammed N.; Jaïs, Pierre; Cummings, Jennifer; Di Biase, Luigi; Sanders, Prashanthan; Martin, David O.; Kautzner, Josef; Hao, Steven; Themistoclakis, Sakis; Fanelli, Raffaele; Potenza, Domenico; Massaro, Raimondo; Wazni, Oussama; Schweikert, Robert; Saliba, Walid; Wang, Paul; Al-Ahmad, Amin; Beheiry, Salwa; Santarelli, Pietro; Starling, Randall C.; Dello Russo, Antonio; Pelargonio, Gemma; Brachmann, Johannes; Schibgilla, Volker; Bonso, Aldo; Casella, Michela; Raviele, Antonio; Haïssaguerre, Michel; Natale, Andrea.

In: New England Journal of Medicine, Vol. 359, No. 17, 23.10.2008, p. 1778-1785.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pulmonary-vein isolation for atrial fibrillation in patients with heart failure

AU - Khan, Mohammed N.

AU - Jaïs, Pierre

AU - Cummings, Jennifer

AU - Di Biase, Luigi

AU - Sanders, Prashanthan

AU - Martin, David O.

AU - Kautzner, Josef

AU - Hao, Steven

AU - Themistoclakis, Sakis

AU - Fanelli, Raffaele

AU - Potenza, Domenico

AU - Massaro, Raimondo

AU - Wazni, Oussama

AU - Schweikert, Robert

AU - Saliba, Walid

AU - Wang, Paul

AU - Al-Ahmad, Amin

AU - Beheiry, Salwa

AU - Santarelli, Pietro

AU - Starling, Randall C.

AU - Dello Russo, Antonio

AU - Pelargonio, Gemma

AU - Brachmann, Johannes

AU - Schibgilla, Volker

AU - Bonso, Aldo

AU - Casella, Michela

AU - Raviele, Antonio

AU - Haïssaguerre, Michel

AU - Natale, Andrea

PY - 2008/10/23

Y1 - 2008/10/23

N2 - Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)

AB - Background: Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure. Methods: In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation. Results: In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another. Conclusions: Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)

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Khan MN, Jaïs P, Cummings J, Di Biase L, Sanders P, Martin DO et al. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. New England Journal of Medicine. 2008 Oct 23;359(17):1778-1785. https://doi.org/10.1056/NEJMoa0708234