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Cardiac resynchronization therapy in patients with permanent atrial fibrillation. Is it mandatory to ablate the atrioventricular junction to obtain a good response?
Author(s) -
Tolosana José María,
Arnau Ana Martín,
Madrid Antonio Hernández,
Macias Alfonso,
Lozano Ignacio Fernández,
Osca Joaquín,
Quesada Aurelio,
Toquero Jorge,
Francés Roberto Matia,
Bolao Ignacio García,
Berruezo Antonio,
Sitges Marta,
Alcalá Mónica Gimenez,
Brugada Josep,
Mont Lluís
Publication year - 2012
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 - 10.1093/eurjhf/hfs024
Subject(s) - medicine , atrial fibrillation , cardiac resynchronization therapy , cardiology , ablation , sinus rhythm , chronotropic , catheter ablation , heart failure , ablation of atrial fibrillation , atrioventricular node , heart rate , ejection fraction , tachycardia , blood pressure
Aim Current guidelines recommend atrioventricular junction (AVJ) ablation in patients with atrial fibrillation (AF) treated with cardiac resynchronization therapy (CRT). Our study compared the CRT response of patients in sinus rhythm (SR) vs. AF. Methods and results In this observational, prospective, multicentre study, patients were grouped by intrinsic rhythm. For the first 2 months, the negative chronotropic drug was optimized in the AF group. If ventricular pacing was ≤85%, AVJ ablation was recommended. Responders were defined as patients who survived without requiring heart transplant and had a ≥ 10% reduction in left ventricular end‐systolic volume (LVESV) at 12 months after implantation. Of 202 patients included, 156 (77%) were in SR and 46 (23%) had AF. After drug optimization, only 13/46 (28%) of the AF patients required AVJ ablation (AF + AVJ). The percentage of responders was 83/156 (53%) for SR vs. 22/46 (48%) AF ( P = 0.4). Among AF patients the response was 16/33 (48%) for AF with non‐AVJ ablation vs. 6/13 (46%) AF + AVJ, P = 0.56. The LVESV decreased in all three groups: −30 ± 39 mL, −24 ± 43 mL, and −22 ± 36 mL, respectively ( P = 0.75). Mortality was higher in patients with AF compared with SR: 10/46 (21%) vs. 9/156 (5.7%), log rank 10.6, P <0.05. Conclusion Although only 28% of the patients in AF had the AVJ ablated, there were no differences in the percentage of response and echo improvement between patients in SR and AF. However, mortality was higher in patients with AF compared with patients in SR.