| Objectives: To compare the effect of atrioventricular nodal ablation and permanent pacing ( AVNAP ) versus atrioventricular nodal modification ( AVNM ) on cardiac performance and quality of life (QOL) for patients with drug refractory atrial fibrillation (AF).Methods: 32 patients with drug refractory AF (19 males, 13 females, mean age 64.1+6.14), were enrolled into consecutively . The patients were divided into AVNAP group (n=18) and AVNM group (n=14). During follow-up we recorded the changes of the two groups, including cardiac performance , QOL, exercise tolerance and the frequency of hospital admission.Results: The two group mean follow-up 14 months. Complete AV block was achieved in all 18 AVNAP group patients. With mean radiofrequency pulses 4+2 times, discharge 180+30 seconds, fluoroscopy average time was 15 + 9 min, one patient suddenly died next day after ablation.In AVNM group instant control of the ventricular rate was successful in 10 of 14 patients(81. 4%), 2 patients operation failed. Inadvertent completer AV block occurred in 2 of 14 patients. During the follow-up 2 patients had return of rapid ventricular conduction between 1 and 3 months after their procedure. One patient died suddenly two weeks after the procedure. Overall, adequate rate control was achieved long term in 7 of 14 patients(50%). In all 14 patients with mean radiofrequency pulses 12+4 times, discharge 300+30 seconds, fluoroscopy average time was 25 + 11 min.In AVNAP group (n=17): Comparing after ablation with before ablation, LVEF was increased from 47%+9% to 57%+6%, p<0.01. LVEDVwas decreased (57 + 7 VS 50+5,p>0.05), NYHA function class was decreased from 2.2+0.7 to 1.4+0.5, p<0.05. Both maximum and rest ventricular rate had decreased significantly (174 + 7bpm VS 110 + 5bpm, and 107 + 10bpm VS 74±3bpm, respectively, p<0.05). The distance of 6-MWT was prolonged (p<0.05), QOL was signification improved , symptoms was significantly reduction. The frequency of hospital admission and emergency room visits, antiarrhythmic drug management were significantly decreased after ablation (p<0.05).In AVNM group (n=7): Comparing after ablation with before ablation , LVEF was increased (48±7 VS 50+6, p>0.05), while LVEDV was decrease (53±5 VS 50+8, p>0<05). NYHA functional class decrease from 2.7+0.7 to 1.5±0.8, p<0.05, both maximum and rest ventricular rate had significantly decreased , all p<0.05, while the distance of 6-MWT had no significantly different. Symptom scores including palpitation , dyspnea, improved significantly , however, symptom scores for dizziness, chest oppression remained unchanged .hospital admission , emergency room visiting for AF and antiarrhythmic drug management decreased significant after modification.Compared AVNAP group with AVNM group, after ablation LVEF was increased (58+6 VS 50+6, p<0.05), the distance of 6-MWT increased (455±43 VS 392+34, p<0.05), maximum and rest ventricular rate had no significantly difference between two groups , emergency room visits and antiarrhythmic drug management AVNAP group was decrease in contrast to AVNM group (p<0.05). After ablation the SF-36 score and NYHA functional were improved in two groups (p<0.05)Conclusion: AVNAP is beneficial to the long-term of patients with drug-refractory AF, it improve the cardiac performance and life-quality, it might be an effective, safe, simple method for control ventricular rate of AF.
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