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| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
{| class="infobox" style="float:right;"
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]  
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Infobox_Disease |
{| class="infobox" style="float:right;"
  Name          = Atrial fibrillation |
|-
  Image          = SinusRhythmLabels.png  |
| [[File:Critical_Pathways.gif|88px|link=Atrial fibrillation critical pathways]]|| <br> || <br>
  Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
|}
  DiseasesDB    = 1065 |
{| class="infobox" style="float:right;"
  ICD10          = {{ICD10|I|48||i|30}} |
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  ICD9          = {{ICD9|427.31}} |
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
  ICDO          = |
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
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{{Atrial fibrillation}}
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{{CMG}}; {{AE}} {{CZ}}
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  eMedicine_mult = {{eMedicine2|emerg|46}} |  
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{{WikiDoc Cardiology Network Infobox}}
{{CMG}}
 
'''Associate Editor-In-Chief:''' {{CZ}}
 
{{Editor Join}}
 
'''Synonyms and related keywords''': AF, Afib, fib
 
==Clinical Trial Data==
 
Results from the Pulmonary Vein Antrum Isolation versus AV Node Ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) study suggest that pulmonary-vein (PV) isolation leads to better morphologic and functional results than atrioventricular (AV) node ablation with biventricular pacing for congestive heart failure (CHF) in patients with atrial fibrillation.


In this prospective, multicenter study, 41 patients were randomized to PV isolation and 40 to AV node ablation with biventricular pacing. At 6 months, patients in the PV isolation group had higher mean ejection fractions (35% vs 29%, p<0.001), greater 6 minute distances walked (340 vs 297 meters, p <0.001), and better quality of life scores as determined by the Minnesota Living with Heart Failure questionnaire (60 vs 82, p<0.001, where lower scores indicate better quality of life) than those in the AV node ablation arm.  
==Supportive Trial Data==
Results from the Pulmonary Vein Antrum Isolation (PVAI) versus AV node ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) study suggest that pulmonary vein (PV) isolation leads to better morphologic and functional results than atrioventricular (AV) node ablation with biventricular pacing for [[congestive heart failure]] (CHF) in patients with atrial fibrillation.  


These PABA-CHF study findings thus suggest the potential advantages of performing PV isolation over AV node ablation with biventricular pacing for this patient population.  
In this prospective, multicenter study, 41 patients were randomized to PV isolation and 40 to AV node ablation with biventricular pacing.  At 6 months, patients in the PV isolation group had higher mean ejection fractions (35% vs 29%, p<0.001), greater 6 minute distances walked (340 vs 297 meters, p <0.001), and better quality of life scores as determined by the Minnesota Living with Heart Failure questionnaire (60 vs 82, p<0.001, where lower scores indicate better quality of life) than those in the AV node ablation arm.  


Noted limitations of the study include using sites with extensive experience in performing ablations, an unblinded study design, and a relatively short follow-up time. (NEJM by Mohammed N. Khan, et al.)
These PABA-CHF study findings thus suggest the potential advantages of performing PV isolation over [[AV node]] ablation with [[Cardiac resynchronization therapy|biventricular pacing]] for this patient population.  


==See Also==
Noted limitations of the study include using sites with extensive experience in performing ablations, an unblinded study design, and a relatively short follow-up time.
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


==Further Readings==
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{{refbegin|2}}
{{WikiDoc Sources}}
* Fuster V, Rydén LE, Cannom DS, et al (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257-354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
[[CME Category::Cardiology]]
* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
{{refend}}
 
{{Electrocardiography}}
{{Circulatory system pathology}}
{{SIB}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
 
[[Category:Needs overview]]
[[de:Vorhofflimmern]]
[[fr:Fibrillation auriculaire]]
[[it:Fibrillazione atriale]]
[[nl:Boezemfibrilleren]]
[[ja:心房細動]]
[[no:Atrieflimmer]]
[[pl:Migotanie przedsionków]]
[[ro:Fibrilaţia Atrială]]
[[fi:Eteisvärinä]]
[[zh:心房颤动]]
[[tr:Atriyal fibrillasyon]]
 
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Latest revision as of 01:20, 15 March 2016



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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Supportive Trial Data

Results from the Pulmonary Vein Antrum Isolation (PVAI) versus AV node ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA-CHF) study suggest that pulmonary vein (PV) isolation leads to better morphologic and functional results than atrioventricular (AV) node ablation with biventricular pacing for congestive heart failure (CHF) in patients with atrial fibrillation.

In this prospective, multicenter study, 41 patients were randomized to PV isolation and 40 to AV node ablation with biventricular pacing. At 6 months, patients in the PV isolation group had higher mean ejection fractions (35% vs 29%, p<0.001), greater 6 minute distances walked (340 vs 297 meters, p <0.001), and better quality of life scores as determined by the Minnesota Living with Heart Failure questionnaire (60 vs 82, p<0.001, where lower scores indicate better quality of life) than those in the AV node ablation arm.

These PABA-CHF study findings thus suggest the potential advantages of performing PV isolation over AV node ablation with biventricular pacing for this patient population.

Noted limitations of the study include using sites with extensive experience in performing ablations, an unblinded study design, and a relatively short follow-up time.

References


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