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I had a dream…
Author(s) -
Leclercq Christophe,
Galand Vincent,
Behar Nathalie,
Martins Raphael
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1243
Subject(s) - medicine , cardiac resynchronization therapy , heart failure , defibrillation , atrial fibrillation , cardiology , randomized controlled trial , population , implantable cardioverter defibrillator , ejection fraction , environmental health
This night, I had a dream... the completion of a randomized controlled multicentre trial comparing different therapeutic strategies in patients with permanent atrial fibrillation (AF) and an indication for cardiac resynchronization device implantation. The endpoint is the combination of mortality and heart failure hospitalizations with a long follow-up; several years, at least three. This trial will answer the crucial question of the real efficacy of cardiac resynchronization therapy (CRT) in this specific population. Cardiac resynchronization therapy is implemented for patients with New York Heart Association (NYHA) class III and IV in the European guidelines since 2005 after the publication of the Multisite Stimulation in Cardiomyopathies (MUSTIC), Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trials. The results of subsequent trials led to extend the recommendations of CRT use to less severe patients (NYHA class II). However, the vast majority of these trials excluded patients with permanent AF.1 The lack of data from randomized controlled trials in patients with AF and CRT is surprising or even incomprehensible if we consider the importance of this population in CRT. According to different surveys or studies, about 25% of patients implanted with a CRT device have AF2 and CRT is recommended by the 2016 European Society of Cardiology guidelines on the management and treatment of heart failure for NYHA class III and IV AF patients with left ventricular ejection fraction <35% and QRS duration >130 ms if a strategy to ensure biventricular capture is in place, or if the patient is expected to return to sinus rhythm.1 The recommendations are based on limited evidence of efficacy of CRT in this specific population without dedicated randomized controlled trials. In this issue of the Journal, Gasparini et al.3 report interesting data suggesting that atrioventricular (AV) node ablation in patients