Long-Term Follow-Up After Atrioventricular Node Ablation in Patients With Atrial Fibrillation: A Nationwide Danish Cohort Study

INTRODUCTION: Atrioventricular node (AVN) ablation after pacemaker implantation is a rate control option for patients with symptomatic atrial fibrillation (AF) when rhythm control with anti-arrhythmic drug therapy and/or ablation with pulmonary vein isolation fails. This study investigated the long-term risk of hospitalization and mortality after AVN ablation using nationwide and population-based registries.

METHODS: All AVN ablations between 2015 and 2021 were identified in the National Danish Ablation Database, and hospitalizations were found in the Danish National Patient Registry. Hospitalizations were compared before and after AVN ablation.

RESULTS: We studied 571 patients who underwent AVN ablation. The mean age was 74.5 ± 8.8 years, and 53% were male. The success rate of the ablations was 98.4% without any major procedure-related complications. Median follow-up time was 2.7 years (IQR: 1.2; 4.6). The annual cardiac hospitalizations decreased from incidence rate (IR) of 2.3 per person-year (95% CI: 2.2; 2.6) before ablation to IR of 0.5 per person-year (95% CI: 0.4; 0.6) after ablation. The IR ratio was 0.38 (95% CI: 0.35; 0.41) and more significant for AF admissions. The overall clinical outcomes were independent for implanted pacing system and clinical patient characteristics. After 2 years of follow-up, mortality was 14.2%, but was associated with high patient age, advanced pacing systems, and substantial cardiac and non-cardiac comorbidities.

CONCLUSION: AVN ablation is associated with an over four-fold reduction of cardiac hospitalization. This procedure has a high success rate and very low risk of complications.