Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation

Abstract

Aims There are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation. Methods and resultsWe retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse-probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P < 0.001), more frequently male (82.5% vs. 75.5%, P = 0.02), and had higher heart rate (75.7 vs. 71.0 b.p.m., P < 0.001). Of the 229 AF patients, 162 (70.7%) received suboptimal CRT (<98%) and 67 (29.3%) had adequate CRT (≥98%). During a median follow-up of 24 months, total mortality did not differ between AF and SR groups (propensity-score-weighted hazard ratio, HR 1.32 [95% confidence interval, 0.82-2.15], P = 0.25). The risk of appropriate shocks was significantly higher in the AF group with <98% CRT than in the SR group ], P = 0.006) and was similar in the AF group with ≥98% CRT versus the SR group (1.29 [0.66-2.53], P = 0.45). During follow-up, sinus rhythm was recovered in 23 patients in the AF group (10%) after a median time of 106 (42-256) days. The rate of sinus rhythm recovery in the AF group was 4.5 (95% CI, 2.8-6.7) per 100 patient-years; the rate of permanent AF occurrence in the SR group was 2.5 (95% CI, 1.9-3.3) per 100 patient-years. Conclusions Although mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ≥ 98%.

The Role of Sacubitril/Valsartan and Gliflozins in Heart Failure with Reduced Ejection Fraction after Cardiac Resynchronization Therapy

“…By contrast, in our study the effectiveness of CRT in ARNi and SGLT2i group was consistent regardless HF etiology, but especially in ICM patients that least responded to the CRT. Interestingly, the other well-known negatively predictors of CRT clinical outcomes (such as atrial fibrillation, RBBB, biventricular pacing) were confirmed in our analysis [30][31][32] .…”

Clinical impacts of sacubitril/valsartan on patients eligible for cardiac resynchronization therapy

“…In our study, only 5.2% patients initially eligible for CRT implantation had LVEF improvement to ≥50% with SAC/VAL treatment alone for 12 months, suggesting the important role of electrical dyssynchrony in a substantial portion of patients. Besides, the previous studies demonstrated that permanent atrial fibrillation may influence biventricular pacing percentage and reverse cardiac remodelling in HFrEF patients receiving CRT implantation 23,24 . Nevertheless, this study showed that the association between the effects of SAC/VAL in reverse cardiac remodelling and permanent atrial fibrillation were insignificant regardless of the QRS durations in Groups 1 and 2.…”

“…Besides, the previous studies demonstrated that permanent atrial fibrillation may influence biventricular pacing percentage and reverse cardiac remodelling in HFrEF patients receiving CRT implantation. 23,24 Nevertheless, this study showed that the association between the effects of SAC/VAL in reverse cardiac remodelling and permanent atrial fibrillation were insignificant regardless of the QRS durations in Groups 1 and 2. Therefore, more studies were warranted to clarify the association of SAC/VAL effects in reverse cardiac remodelling and permanent atrial fibrillation in HFrEF patients with different QRS durations.…”

Acute echocardiographic and electrocardiographic effects of triggered left ventricular pacing

“…However, several studies revealed a necessity for high bi-ventricular (BiV) pacing rates to achieve these beneficial effects [8][9][10][11]. In clinical practice, reaching high BiV pacing rates might be challenging due to rapid intrinsic atrioventricular conduction during atrial tachycardia or atrial fibrillation [12][13][14]. Furthermore, premature ventricular contractions (PVC) can lead to a significant reduction in BiV pacing rates [15,16].…”