Title: Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation
Aims:To assess the clinical benefit of cardiac resynchronization
therapy (CRT) in patients with atrial fibrillation (AF) compared with
patients in sinus rhythm (SR), and to evaluate the impact of
atrioventricular junction (AVJ) ablation on the outcome of AF patients
undergoing CRT.
Methods and results:We conducted a retrospective analysis of 131
consecutive heart failure (HF)patients who underwent CRT implantation.
Three groups were considered: SR (n ¼ 78), AF with AVJ ablation (n ¼
26), and AF without AVJ ablation (n ¼ 27). Patients were evaluated for
the occurrence of cardiac death, hospitalization for HF, and
responsiveness to CRT (survival with improvement of _1 New York Heart
Association class at 6 months). The three groups showed a significant
improvement in functional class. However, the proportion of responders
was significantly lower in AF patients without AVJ ablation (52 vs. 79%
in SR and 85% in AF with AVJ ablation, P , 0.008). Atrial fibrillation
without AVJ ablation was also independently associated with mortality
(HR 5.22, 95% CI: 1.60-17.01, P ¼ 0.006) and hospitalization for HF
during the first 12 months (HR 6.23, 95% CI: 2.09-18.54, P ¼ 0.001).The
outcomes of AF with AVJ ablation patients were similar to the outcomes
of patients in SR.
Conclusion:Sinus rhythm and AF patients display similar survival and
clinical improvement after CRT implantation, provided that AVJ ablation
is performed in the latter.
