Cardiac resynchronization therapy in patients with permanent atrial fibrillation. Is it mandatory to ablate the atrioventricular junction to obtain a good response?
| Autor: | Ignacio Fernández Lozano, José María Tolosana, Joaquín Osca, Antonio Berruezo, Roberto Matía Francés, Aurelio Quesada, Lluís Mont, Marta Sitges, Alfonso Macias, Josep Brugada, Ana Martin Arnau, Ignacio García Bolao, J. Toquero, Spare Ii investigators, Mónica Gimenez Alcala, Antonio Hernández Madrid |
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| Rok vydání: | 2012 |
| Předmět: |
Chronotropic
Male medicine.medical_specialty medicine.medical_treatment Statistics as Topic Cardiac resynchronization therapy Kaplan-Meier Estimate Cardiac Resynchronization Therapy Risk Factors Internal medicine Atrial Fibrillation Confidence Intervals Medicine Humans Sinus rhythm Aged Ultrasonography Analysis of Variance business.industry Atrial fibrillation medicine.disease Ablation Confidence interval Log-rank test Spain Heart failure Cardiology Atrioventricular Node Catheter Ablation Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European journal of heart failure. 14(6) |
| ISSN: | 1879-0844 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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