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J Am Coll Cardiol, 2003; 41:1697-1702, doi:10.1016/S0735-1097(03)00338-3 © 2003 by the American College of Cardiology Foundation |
* Department of Cardiology, Royal Perth Hospital, Perth, Australia
Perth Cardiovascular Institute, Hollywood Private Hospital, Nedlands, Australia
Department of Cardiology, Royal North Shore Hospital, St. Leonards, Australia
Department of Cardiology, Flinders Medical Centre, Bedford Park, Australia
|| Department of Cardiology, John Hunter Hospital, Newcastle, Australia
¶ Department of Public Health, University Of Western Australia, Crawley, Australia
Manuscript received May 23, 2002; revised manuscript received November 22, 2002, accepted December 18, 2002.
* Reprint requests and correspondence: Dr. Rukshen Weerasooriya, Department of Cardiology, Royal Perth Hospital, GPO Box X2213, Perth, Western Australia.
rukshen{at}hotmail.com
OBJECTIVES: The Australian Intervention Randomized Control of Rate in Atrial Fibrillation Trial was a multicenter trial of atrioventricular junction ablation and pacing (AVJAP) compared with pharmacologic ventricular rate control (medication [MED]) in patients with mild to moderately symptomatic permanent atrial fibrillation (AF).
BACKGROUND: There have been very few prospective randomized trials, undertaken in highly symptomatic patients, comparing AVJAP with pharmacologic methods of ventricular rate control for patients with permanent AF.
METHODS: There were 99 patients (70 men, mean age 68 ± 8.6 years) at five centers. Forty-nine patients were randomized to AVJAP while 50 patients were randomized to pharmacologic control. The primary end point was cardiac function measured by echocardiography and exercise tolerance. The secondary end points were ventricular rate control, evaluated by 24-h ambulatory electrocardiographic monitoring, and quality of life. Data were collected at randomization and then at one month, six months, and 12 months post-randomization.
RESULTS: At 12 months follow-up there was no significant difference in left ventricular ejection fraction (AVJAP: 54 ± 17%; MED: 61 ± 13% [p = ns]) or exercise duration on treadmill testing (AVJAP: 4.1 ± 2 min; MED: 4.6 ± 2 min [p = ns]); however, the peak ventricular rate was lower in the AVJAP group during exercise (112 ± 17 beats/min vs. 153 ± 36 beats/min, p < 0.05) and activities of daily life (117 ± 16 beats/min vs. 152 ± 37 beats/min, p < 0.05). The CAST quality-of-life questionnaire revealed that patients in the AVJAP group had fewer symptoms at six months (p = 0.003) and at 12 months (p = 0.004). The observed relative risk reduction in symptoms at 12 months was 18%. Global subjective semiquantitative measurement of quality of life using the "ladder of life" revealed that the AVJAP group reported a 6% better quality of life at six months (p = 0.011).
CONCLUSIONS: In this trial, AVJAP for patients with mild to moderately symptomatic permanent AF did not worsen cardiac function during long-term follow-up, and quality of life was improved.
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