Results of the Multicenter RENEWALR 3 AVT Clinical Study of Cardiac Resynchronization Defibrillator Therapy in Patients with Paroxysmal Atrial Fibrillation

Autor: Rhonda Van Genderen, Michael V. Orlov, Ruth Ann Greenfield, Charles C. Nydegger, Leslie A. Saxon, Brian G. Crandall
Rok vydání: 2006
Předmět:
Zdroj: Journal of Cardiovascular Electrophysiology. 17:520-525
ISSN: 1540-8167
1045-3873
DOI: 10.1111/j.1540-8167.2006.00440.x
Popis: Results of the RENEWAL® 3 AVT Clinical Study. Introduction: Atrial fibrillation impacts the clinical course of up to 50% of patients with advanced heart failure (HF) who are eligible for cardiac resynchronization therapy with a defibrillator (CRT-D). While RV-based defibrillators are available with advanced atrial diagnostics and therapies that provide rapid diagnosis and treatment of spontaneously occurring atrial tachycardia/fibrillation (AT/AF) episodes, there is no CRT-D device that combines atrial/ventricular and CRT therapies. Purpose: The purpose of the prospective multicenter RENEWAL® 3 AVT study is to assess the performance of atrial diagnostics and therapies used in combination with a CRT-D device. Methods: Enrolled patients were required to have indications for a CRT-D device and a documented episode of AT/AF within 12 months of enrollment. A total of 170 patients were enrolled over 9 months (85% male; mean age 72 ± 10 years; NYHA classification: 88% III, 12% IV; left ventricular ejection fraction [LVEF] mean 23 ± 6%; mean QRS duration 150 ± 25 msec; 78% ischemic etiology). The documented atrial arrhythmia was AF in 77% of patients. A total of 60% of patients had the CRT-D device placed for primary prevention of sudden death and 40% of patients had a history of ventricular arrhythmia in addition to HF. The device operates in the biventricular (BiV) triggered mode for sensed ventricular events associated with AF. Results: A total of 159 patients (95%) had a successful CRT-D implant. Over a mean follow-up of 5.7 ± 2.3 months, there were a total of 152 atrial shocks delivered in 108 patients for induced (93%) or spontaneous (7%) occurring episodes of AF. Spontaneously occurring AF was observed in 40 patients (25%). The rate of first shock conversion was 118/152 (78%, mean energy 11.6 ± 5.9 J). Overall shock therapy conversion rate was 138/152 (91%). The number of shock conversions resulting in sinus rhythm maintained for at least 2 minutes postshock was 87% for induced episodes. Therapy was delivered for spontaneous ventricular tachycardia/fibrillation in nine patients (6%). There was no instance of ventricular proarrhythmia associated with atrial shock therapies, undersensing of ventricular arrhythmias, or interruption of CRT therapy associated with the combined device. Conclusions: In CRT-D candidates with a history of AF, 25% experience recurrent AF within 6 months of implant. Atrial detection and ventricular detection, shock, and resynchronization therapies are not compromised by the addition of atrial therapies to a CRT-D device. (J Cardiovasc Electrophysiol, Vol. 17, pp.
Databáze: OpenAIRE
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