Maurizio Gasparini1, Christophe Leclercq2, Maurizio Lunati3, Maurizio Landolina4, Angelo Auricchio5, Massimo Santini6, Giuseppe Boriani7, Barbara Lamp8, Alessandro Proclemer9, Antonio Curnis10, Catherine Klersy11, Francisco Leyva12. 1. Electrophysiology and Pacing Unit, Humanitas Research Hospital, Rozzano, Italy. Electronic address: maurizio.gasparini@humanitas.it. 2. Department of Cardiology, University Hospital Rennes, Rennes, France. 3. Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy. 4. Cardiology Department, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy. 5. Fondazione Cardiocentro Ticino, Lugano, Switzerland. 6. Department of Cardiology, San Filippo Neri Hospital, Rome, Italy. 7. Institute of Cardiology, University of Bologna and Azienda Ospedaliera Sant' Orsola-Malpighi, Bologna, Italy. 8. Department of Cardiology, Heart and Diabetes Centre NRV, Bad Oeynhausen, Germany. 9. Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy. 10. Cardiology Department, Spedali Civili, Brescia, Italy. 11. Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. 12. Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Abstract
OBJECTIVES: The purpose of this study is to determine whether, in patients with atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT), atrioventricular junction ablation (AVJA) is associated with a better outcome than treatment with rate-slowing drugs. BACKGROUND: Different trials have demonstrated that CRT is effective in treating heart failure (HF) patients who are in sinus rhythm (SR). No trials have addressed whether CRT confers similar benefits on AF patients, with or without AVJA. METHODS: The clinical outcomes of CRT for patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) were compared with those of SR patients (n = 6,046). RESULTS: Median follow-up was 37 months. Total mortality (6.8 vs. 6.1 per 100 person-years) and cardiac mortality (4.2 vs. 4.0) were similar for patients with AF+AVJA and patients in SR (both p = NS). In contrast, the AF+drugs group had a higher total and cardiac mortality than the SR group and the AF+AVJA group (11.3 and 8.1, respectively; p < 0.001). On multivariable analysis, AF+AVJA had total mortality (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74 to 1.67) and cardiac mortality (HR: 0.88, 95% CI: 0.66 to 1.17) similar to that of the SR group, independent of known confounders. The AF+drugs group, however, had a higher total mortality (HR: 1.52, 95% CI: 1.26 to 1.82) and cardiac mortality (HR: 1.57, 95% CI: 1.27 to 1.94) than both the SR group and the AF+AVJA group (both p < 0.001). CONCLUSIONS: Long-term survival after CRT among patients with AF+AVJA is similar to that observed among patients in SR. Mortality is higher for AF patients treated with rate-slowing drugs.
OBJECTIVES: The purpose of this study is to determine whether, in patients with atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT), atrioventricular junction ablation (AVJA) is associated with a better outcome than treatment with rate-slowing drugs. BACKGROUND: Different trials have demonstrated that CRT is effective in treating heart failure (HF) patients who are in sinus rhythm (SR). No trials have addressed whether CRT confers similar benefits on AFpatients, with or without AVJA. METHODS: The clinical outcomes of CRT for patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) were compared with those of SRpatients (n = 6,046). RESULTS: Median follow-up was 37 months. Total mortality (6.8 vs. 6.1 per 100 person-years) and cardiac mortality (4.2 vs. 4.0) were similar for patients with AF+AVJA and patients in SR (both p = NS). In contrast, the AF+drugs group had a higher total and cardiac mortality than the SR group and the AF+AVJA group (11.3 and 8.1, respectively; p < 0.001). On multivariable analysis, AF+AVJA had total mortality (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74 to 1.67) and cardiac mortality (HR: 0.88, 95% CI: 0.66 to 1.17) similar to that of the SR group, independent of known confounders. The AF+drugs group, however, had a higher total mortality (HR: 1.52, 95% CI: 1.26 to 1.82) and cardiac mortality (HR: 1.57, 95% CI: 1.27 to 1.94) than both the SR group and the AF+AVJA group (both p < 0.001). CONCLUSIONS: Long-term survival after CRT among patients with AF+AVJA is similar to that observed among patients in SR. Mortality is higher for AFpatients treated with rate-slowing drugs.
Authors: Liang-Han Ling; Peter M Kistler; Jonathan M Kalman; Richard J Schilling; Ross J Hunter Journal: Nat Rev Cardiol Date: 2015-12-10 Impact factor: 32.419
Authors: Finn Akerström; Moisés Rodríguez Mañero; Marta Pachón; Alberto Puchol; Xesús Alberte Fernández López; Luis Martínez Sande; Miguel Valderrábano; Miguel A Arias Journal: J Atr Fibrillation Date: 2015-08-31