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Review
. 2011 Sep 30;4(3):334.
doi: 10.4022/jafib.334. eCollection 2011 Sep-Nov.

Cardiac Resynchronization Therapy and Atrial Fibrillation

Ganesh S Kamath  1 , Jonathan S Steinberg  1
Affiliations
Review

Cardiac Resynchronization Therapy and Atrial Fibrillation

Ganesh S Kamath et al. J Atr Fibrillation. .

Abstract

Cardiac resynchronization therapy (CRT) is an important advance for the treatment of end--stage heart failure (HF). About 15-50% of HF is complicated by atrial fibrillation (AF) and associated with worsened outcomes. Meta-analyses from observational studies suggest that patients with AF derive similar benefits to CRT as patients in sinus rhythm (SR). The presence of AF, however, may interfere with optimal delivery of CRT due to competition with biventricular (BiV) capture by conducted beats. Atrioventricular junction (AVJ) ablation with permanent pacing eliminates interference by conducted beats and provides complete BiV capture. Catheter ablation of AF is an alternative to antiarrhythmic drugs to maintain sinus rhythm in patients with AF and HF. Randomized trial comparing catheter ablation, AVJ ablation and pharmacologic therapy are needed.

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Figures

Figure 1
Figure 1. Kaplan-Meier estimates of the time to the various clinical end-points in patients with atrial fibrillation (AF) and patients in sinus rhythm (SR). HF, Heart failure; MCE, major cardiovascular events. No significant group differences emerged with respect to any of the end-points.
Figure 2
Figure 2. Responders had a higher percentage of fully paced beats than nonresponders (p = 0.03). Nonresponders had a significantly higher percentage of ineffective pacing because of a combination of fusion (p = 0.04) and pseudo-fusion (p = 0.02) beats [Adapted from Kamath et al. J Am Coll Cardiol. 2009; 53: 1050-1055]
Figure 3
Figure 3. Kaplan–Meier estimates of overall (A), cardiac (B), and heart failure (C) survival between AF pts who underwent atrio-ventricular junction ablation (AVJ-abl) and AF patients treated only with negative dromotropic drugs (AF-Drugs) [Adapted from Gasparini et al. Eur Heart J 2008: 29; 1644–1652]with respect to any of the end-points.
Figure 4
Figure 4. Hazard ratio estimates stratified according to cause of death between atrial fibrillation patients who underwent atrio-ventricular junction ablation (AVJ-abl) and patients treated with negative dromotropicdrugs (AF-Drugs) [Adapted from Gasparini et al. Eur Heart J 2008: 29; 1644–1652]
Figure 5
Figure 5. Improvement in left ventricular (LV) function and dimensions after ablation in patients with congestive heart failure [Adapted from Khan et al. N Engl J Med 2004; 359: 1778-1785]
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