{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:53:19Z","timestamp":1787017999678,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1999,3,30]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    \u2014Atrioventricular (AV) node ablation and pacing has become accepted therapy for drug-refractory paroxysmal atrial fibrillation (PAF). However, few data demonstrate its superiority over continued medical therapy. The influence of pacing mode and mode-switch algorithm has not been investigated.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    \u2014Symptomatic patients who had tried \u22652 drugs for PAF were randomized to continue medical therapy (n=19) or AV junction ablation and implantation of dual-chamber mode-switching (DDDR\/MS) pacemakers (slow algorithm [n=19] or fast algorithm [n=18]). Follow-up over 18 weeks was at 6-week intervals and used quality-of-life questionnaires (Psychological General Well Being [PGWB], McMaster Health Index [MHI], cardiac symptom score), exercise testing, echocardiography, and Holter monitoring. Paced patients were randomized to DDDR\/MS or VVIR and subsequently crossed over. Ablation and DDDR\/MS pacing produced better scores than drug therapy for overall symptoms (\u221241%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01), palpitations (\u221258%,\n                    <jats:italic>P<\/jats:italic>\n                    =0.0001), and dyspnea (\u221237%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.05). Changes in score from baseline were better with ablation and DDDR\/MS pacing for overall symptoms (\u221248% versus \u22124%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.005), palpitation (\u221262% versus \u22125%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001), dyspnea (\u221244% versus \u22123%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.005), and PGWB (+12% versus +0.5%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.05). DDDR\/MS was better than VVIR pacing for overall symptoms (\u221221%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.05), dyspnea (\u221230%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.005), and MHI (+5%,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.03). There were no differences between algorithms. More patients developed persistent AF with ablation and pacing than with drugs at 6 weeks (12 of 37 versus 0 of 19,\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    \u2014Ablation and DDDR\/MS pacing produces more symptomatic benefit than medical therapy or ablation and VVIR pacing but may result in early development of persistent AF.\n                  <\/jats:p>","DOI":"10.1161\/01.cir.99.12.1587","type":"journal-article","created":{"date-parts":[[2012,6,11]],"date-time":"2012-06-11T20:42:29Z","timestamp":1339447349000},"page":"1587-1592","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":82,"title":["Prospective Randomized Study of Ablation and Pacing Versus Medical Therapy for Paroxysmal Atrial Fibrillation"],"prefix":"10.1161","volume":"99","author":[{"given":"Howard J.","family":"Marshall","sequence":"first","affiliation":[{"name":"From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe\u0308 I.","family":"Harris","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Griffith","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger L.","family":"Holder","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Gammage","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine and Department of Mathematics and Statistics (R.L.H.), University of Birmingham, Birmingham, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198204293061703"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1995.tb04738.x"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.79.6.543"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)91214-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.94.7.1585"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.90.5.7955187"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(96)90528-1"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1995.tb06982.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90394-5"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.96.8.2617"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Ovsyshcher IE Katz A Bondy C. Initial experience with a new algorithm for automatic mode switching from DDDR to DDIR mode. Pacing Clin Electrophysiol. 1994;17(pt 2):1908\u20131912.","DOI":"10.1111\/j.1540-8159.1994.tb03772.x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"den Dulk K Dijkman B Pieterse M Wellens H. Initial experience with mode switching in a dual sensor dual chamber pacemaker in patients with paroxysmal atrial tachyarrhythmias. Pacing Clin Electrophysiol. 1994;17(pt 2):1900\u20131907.","DOI":"10.1111\/j.1540-8159.1994.tb03771.x"},{"key":"e_1_3_2_13_2","unstructured":"Dupuy HJ. The psychological general well-being (PGWB) index. In: Chambers LW Dupuy HJ eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapy. New York NY: Le Jacq Publishing; 1984:170\u2013183."},{"key":"e_1_3_2_14_2","unstructured":"Chambers LW. The McMaster health index questionnaire. In: Chambers LW Dupuy HJ eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Therapy. 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