The Utility of 12-Lead Holter Monitoring in Patients With Permanent Atrial Fibrillation for the Identification of Nonresponders After Cardiac Resynchronization Therapy

Kamath, Ganesh S; Cotiga, Delia; Koneru, Jayanthi N.; Arshad, Aysha; Pierce, Walter; Aziz, Emad F.; Mandava, Anisha; Mittal, Suneet; Steinberg, Jonathan S.

doi:10.1016/j.jacc.2008.12.022

Cited by 150 publications

(76 citation statements)

References 25 publications

(17 reference statements)

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“…The result of RAFT (Resynchronization for Ambulatory Heart Failure Trial) 29 revealed that, although patients with permanent AF had to be adequately rate controlled (resting ventricular rate ≤60/min and a ventricular rate <90/min after the 6MWT) before randomization, only one-third of CRT patients received ≥95% of BiVP. Even this may be an overestimate because the percentage of BiVP recorded by device counters is often artificially inflated during AF due to erroneous counting of the above-mentioned fusion or pseudofusion complexes, 30 which needs further evaluation in appropriately designed studies.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, AV delay programming and biventricular triggering parameters may have a role in improving the percentage of BiVP. 20,30,36 Meanwhile, it seems reasonable not to perform AVN ablation systematically at the time of CRT implantation, but instead to perform it a few weeks later if BiVP is suboptimal (<95%-99%) despite adequate pharmacological optimization of ventricular heart rate. Results of ongoing randomized studies may further clarify whether AVN ablation should routinely accompany CRT in patients with AF.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Farmakološka kontrola frekvencije ventrikula početni je izbor liječenja u tih bolesnika, ali su lijekovi koji se rabe u tu svrhu rijetko dovoljni da osiguraju visoki postotak stimulacije bez fuzijskih kontrakcija. 21 Beta-blokatori se preporučuju kao terapija prve linije za kontrolu frekvencije ventrikula zbog njihove učinkovitosti pri visokom tonusu simpatikusa.…”

Section: 20unclassified

Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options

Petrač¹

2017

Cardiologia Croatica

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Fibrilacija atrija u bolesnika s resinkronizacijskom terapijom srca: terapijske mogućnosti Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options SAŽETAK: Fibrilacija atrija (FA) često je prisutna u bolesnika s resinkronizacijskom terapijom srca (CRT) i može imati znatan negativan utjecaj na prognozu i odgovor na CRT. Liječenje FA-a u bolesnika s CRT-om uključuje optimalnu medikamentu terapiju za zatajivanje srca, antikoagulantnu terapiju i terapiju za kontrolu frekvencije ili kontrolu ritma sa specifičnim ciljem da se osigura visoki postotak (≥98 %) biventrikularne (BiV) stimulacije. U bolesnika sa zatajivanjem srca i FA-om, kontrola ritma antiaritmičnim lijekovima nije uspjela pokazati nikakvu dobit u preživljenju u usporedbi s lijekovima za kontrolu frekvencije. U tom kontekstu kontrola frekvencije lijekovima preferira se kao prvi izbor liječenja u bolesnika s CRT-om i perzistentnom ili trajnom FA. Međutim, opservacijske prospektivne studije i metaanalize pokazuju da je ablacija AV spoja bolja od lijekova za kontrolu frekvencije u postizanju visokog postotka BiV stimulacije i smanjenju smrtnosti. Zbog toga ablacija AV spoja može biti prvi izbor liječenja u bolesnika s CRT-om i trajnom FA. Amiodaron i dofetilid jedini su antiaritmici pogodni za kontrolu ritma u bolesnika s CRT-om, ali uz umjerenu učinkovitost i znatne nuspojave. Kateterska ablacija FA-a drugi je mogući izbor za kontrolu ritma u bolesnika sa CRT-om, jer poboljšava odgovor na CRT pospješujući atrioventrikularnu i interventrikularnu sinkroniju. Prema rezultatima randomiziranih kontroliranih studija u bolesnika sa zatajivanjem srca, ablacija FA može se uzeti u obzir u bolesnika s CRT-om i paroksizmalnom FA, koji ne reagiraju na antiaritmične lijekove, kao i u odabranih bolesnika s perzistentnom FA prije nego što se prihvati terapija za kontrolu frekvencije. SUMMARY:Atrial fibrillation (AF) is often present in patients with cardiac resynchronization therapy (CRT), and may have a significant negative impact on the prognosis and CRT response. Management of AF in CRT patients includes the optimal pharmacological heart failure therapy, anticoagulation therapy, and rate or rhythm control therapy with specific goal to ensure a high percentage (≥98%) of biventricular (BiV) pacing. In heart failure patients with AF, a rhythm control with antiarrhythmic drugs has failed to show any survival benefit compared with a rate control drugs. In this context, a rate control with drugs is preferred as first-line therapy in CRT patients with persistent or permanent AF. However, the observational prospective studies and meta-analyses indicate that AV junction ablation is superior to rate control drugs in achieving adequate BiV pacing and reducing mortality. Therefore, an ablation of AV junction should be considered as the first therapeutic choice in CRT patients with permanent AF. Amiodarone and dofetilide are the lone antiarrhythmic drugs suitable for the rhythm control in CRT patients, but with a moderate efficacy and significant ...

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“…El ritmo de FA competitivo -que crea latidos espontá-neos, de fusión o de seudofusión-podría reducir el ritmo de la verdadera captura biventricular. Un análisis cuidadoso del ECG superficial es obligatorio, y en algunos casos podría ser útil una grabación de Holter, para evaluar que la captura biventricular es completa y excluir la seudofusión que los algoritmos del dispositivo podrían registrar como latidos con estimulación cardiaca 96 . En la mayoría de los pacientes con FA y conducción AV intacta, la entrega adecuada de estimulación biventricular solo se puede lograr mediante ablación del nodo AV, que algunos autores requieren sistemáticamente para estos pacientes.…”

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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The Utility of 12-Lead Holter Monitoring in Patients With Permanent Atrial Fibrillation for the Identification of Nonresponders After Cardiac Resynchronization Therapy

Cited by 150 publications

References 25 publications

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

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

Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

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