Electrical Cardioversion, Ablation or Pace and Ablate for Persistent Atrial Fibrillation

Launched by EASTBOURNE GENERAL HOSPITAL · Aug 18, 2015

Keywords

ClinConnect Summary

the National Institute for Health and Care Excellence (NICE) suggest the following treatments options can be considered for patients with recurrent persistent atrial fibrillation:

1. Direct current cardioversion (DCCV) with concomitant anti-arrhythmic treatment.
2. Permanent pacemaker implantation (PPM) and atrio-ventricular (AV) node ablation.
3. Left atrial catheter ablation.

These treatment options have not been directly compared and each has their own advantages and disadvantages.

1. DC cardioversion is highly successful at restoring sinus rhythm and is a relatively cheap interventio...

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Patients with symptomatic persistent atrial fibrillation of less than 1-year duration.
• • Patients must be over 65 years old.
• • Patients give informed consent prior to participating in this study.
• Exclusion Criteria:
• • Paroxysmal atrial fibrillation.
• • Long-standing persistent or permanent atrial fibrillation.
• • Previous pacemaker implantation.
• • Previous atrial ablation.
• • Patient is unable to take warfarin or other oral anti-coagulant medication.
• • Patient is suffering with unstable angina in last one week.
• • Patient has had a myocardial infarction within last two months.
• • Patient is expecting or has had major cardiac surgery within last two months.
• • Patient is participating in a conflicting study.
• • Patient is unable to perform exercise testing.
• • Patient is mentally incapacitated and cannot consent or comply with follow-up.
• • Patient has New York Heart Association (NYHA) class III/IV heart failure.
• • Patient has left ventricular ejection fraction (LVEF) less than 35% not secondary to tachycardia.
• • Pregnancy.
• • Patient suffers with other cardiac rhythm disorders.
• • Recent coronary artery intervention or other factors suggesting clinical instability (ECG, clinical or laboratory findings).