Comparison of Usefulness of Cardiac Resynchronization Therapy in Patients With Atrial Fibrillation and Heart Failure Versus Patients With Sinus Rhythm and Heart Failure

Delnoy, Peter Paul H.M.; Ottervanger, Jan Paul; Luttikhuis, Henk Oude; Elvan, Arif; Misier, Anand R. Ramdat; Beukema, Willem P.; Hemel, Norbert M. van

doi:10.1016/j.amjcard.2006.12.040

Cited by 122 publications

(74 citation statements)

References 24 publications

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“…22 Delnoy et al showed that the benefit of CRT in patients with chronic AF and HF was similar to that in patients with SR, and that long-term survival after CRT did not differ between the AF and SR groups. 25 We evaluated the clinical and echocardiographic effects of CRT in patients with and without chronic AF and there was no significant difference in the frequency of responders between the AF and SR groups, which was a similar finding to that of a previous report. 22 In both groups, the LV dyssynchrony in the responders improved significantly compared with that in the non-responders.…”

Section: Comparison Of Response To Crt In Patients With Sr Vs Chronic Afsupporting

confidence: 75%

Change in Blood Pressure Just After Initiation of Cardiac Resynchronization Therapy Predicts Long-Term Clinical Outcome in Patients With Advanced Heart Failure

Tanaka

Tada

Yamashita

et al. 2009

Circ J

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Circ J 2009; 73: 288 -294 ardiac resynchronization therapy (CRT) improves the quality of life, symptoms, and exercise capacity of patients with drug-refractory congestive heart failure (HF) and intraventricular conduction delays. 1 In addition, CRT has resulted in a reduction in HF hospitalizations and the risk of death. 1,2 However, the indication for CRT remains limited by a fairly high percentage of nonresponsive patients. 1,3 Previous reports have suggested that baseline mechanical ventricular dyssynchrony may predict the hemodynamic response to CRT, 4,5 but there are some non-responders to CRT despite an improvement in the left ventricular (LV) dyssynchrony. Thus, predictors of CRT response and the long-term outcome of CRT have not been sufficiently clarified.Atrial fibrillation (AF) often occurs in patients with advanced HF and in CRT recipients, 6,7 but previous large trials have examined the effectiveness of CRT only in patients with sinus rhythm (SR). 1-4 Therefore, the efficacy and safety of CRT for patients with AF have not been fully established.The purpose of this study was to identify CRT responders in order to predict the short-and long-term clinical outcomes and to examine the efficacy of CRT in patients with AF. Methods Study PopulationThis study included 43 patients (10 women; mean age, 66±9 years) with advanced HF and a wide QRS complex who received a pacemaker or implantable cardioverter defibrillator providing biventricular pacing (Table 1). Fourteen (33%) patients had ischemic heart disease, 24 (56%) had idiopathic cardiomyopathy, 2 (5%) had valvular heart disease, 1 (2%) had arrhythmogenic right ventricular (RV) cardiomyopathy, and the remaining 2 (5%) had cardiac sarcoidosis. At the time of CRT, 18 (42%) patients were in New York Heart Association (NYHA) function class 4, and the remaining 25 (58%) were in class 3 despite maximal pharmacologic therapy before CRT. In all patients, the total QRS duration was >140 ms (range, 140-280 ms) and the LV ejection fraction (LVEF) determined by echocardiography was <40% (mean LVEF, 25±11%) with extensive dilation of the left ventricle (LV end-diastolic dimension, 70±11 mm; Table 1). In total, 20 (47%) patients had chronic AF and the remaining 23 (53%) were in SR.After assessing the patients' clinical status and examining their cardiac function by echocardiography before and 1 month after CRT initiation, they were divided into 2 groups: responders and non-responders. A responder was defined as a patient who improved clinically to NYHA function class I or II during the follow-up period and whose LV endsystolic volume (LVESV) decreased by 10% and/or LVEF (Received June 6, 2008; revised manuscript received September 20, 2008; accepted October 7, 2008; released online December 26, 2008 Background The aim of this study was to retrospectively investigate the long-term effect of cardiac resynchronization therapy (CRT) and to clarify the useful predictors of clinical outcome. Methods and ResultsThe study group comprised 43 patients with advanced heart fa...

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Section: Comparison Of Response To Crt In Patients With Sr Vs Chronic Afsupporting

confidence: 75%

Change in Blood Pressure Just After Initiation of Cardiac Resynchronization Therapy Predicts Long-Term Clinical Outcome in Patients With Advanced Heart Failure

Tanaka

Tada

Yamashita

et al. 2009

Circ J

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“…34 The benefit reported with AVN ablation should be interpreted according to different clinical characteristics of patients selected for therapy. Delnoy et al 5 showed a clear benefit of CRT in a population of patients with AF, with a minority of patients undergoing AVN ablation. This may have been driven by higher rates of biventricular capture in their study, in which 90% of AF patients achieved >90% biventricular capture.…”

mentioning

confidence: 99%

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

Yin

Wang

et al. 2014

Clinical Cardiology

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Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure (HF) and wide QRS configuration, especially for those in sinus rhythm. However, for those with permanent AF, atrioventricular nodal (AVN) ablation use remains under debate. Our objective was to evaluate clinical outcomes and mortality of AVN ablation in HF patients with permanent AF receiving CRT. Electronic publication database and reference lists through October 1, 2013 were searched. Observational cohort studies comparing CRT patients with AF who received either AVN ablation or medical therapy were selected. Outcomes included mortality, CRT nonresponse, changes in left ventricular remodeling, and functional outcomes, such as New York Heart Association (NYHA) functional class, quality of life, and 6-minute hall walk distance. Of 1641 reports identified, 13 studies with 1256 patients were included. Among patients with permanent AF and insufficient biventricular pacing (<90%), those who had undergone AVN ablation compared to those who did not had numerically lower all-cause mortality (risk ratio [RR]: 0.63, 95% confidence interval [CI]: 0.42 to 0.96, P = 0.03) and significantly lower nonresponse to CRT (RR: 0.41, 95% CI: 0.31 to 0.54, P < 0.00001). Furthermore, AVN ablation was not associated with additional improvements on left ventricular ejection fraction, NYHA functional class, 6-minute hall walking distance, and quality of life. In patients with permanent AF undergoing CRT, AVN ablation tended to reduce mortality potentially and improved clinical response when it was applied to patients with inadequate biventricular pacing (<90%). Randomized controlled trials are needed to further address the efficacy of AVN ablation among this population.

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“…En una revisión sistemática reciente 99 , la TRC y la ablación del nodo AV se asociaron a reducción sustancial de la mortalidad por cualquier causa (cociente de riesgos instantáneos = 0,42) y la mortalidad cardiovascular (cociente de riesgos instantáneos = 0,44) y mejoría en la clase funcional de la NYHA (cociente de riesgos instantáneos = 0,52), en comparación con la TRC sin ablación del nodo AV. Por el contrario, otros estudios 97,[103][104][105] que constataron similares mejorías de SR y FA respaldan una estrategia inicial conservadora para los pacientes con FA optimizando el tratamiento médico y programando el dispositivo de TRC para obtener un porcentaje de estimulación ventricular más alto, y reservando la ablación del nodo AV solo para pacientes con mal control del ritmo.…”

Section: Insuficiencia Cardiaca Qrs Intrínseco ≥ 120 Ms Y Fracción Dunclassified

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

Brignole

Auricchio

Barón-Esquivias

et al. 2014

Revista Española de Cardiología (English Edition)

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Comparison of Usefulness of Cardiac Resynchronization Therapy in Patients With Atrial Fibrillation and Heart Failure Versus Patients With Sinus Rhythm and Heart Failure

Cited by 122 publications

References 24 publications

Change in Blood Pressure Just After Initiation of Cardiac Resynchronization Therapy Predicts Long-Term Clinical Outcome in Patients With Advanced Heart Failure

Change in Blood Pressure Just After Initiation of Cardiac Resynchronization Therapy Predicts Long-Term Clinical Outcome in Patients With Advanced Heart Failure

Effects of Atrioventricular Nodal Ablation on Permanent Atrial Fibrillation Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta‐analysis

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

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