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. 2019 Mar;16(3):416-423.
doi: 10.1016/j.hrthm.2018.09.028. Epub 2018 Sep 29.

Positive impact of pulmonary vein isolation on biventricular pacing in nonresponders to cardiac resynchronization therapy

Thomas Fink  1 , Enida Rexha  2 , Michael Schlüter  3 , Christine Lemes  2 , Tilman Maurer  2 , Christian-Hendrik Heeger  2 , Bruno Reissmann  2 , Laura Rottner  2 , Tobias Tönnis  2 , Amaar Ujeyl  2 , Matthias Krüger  2 , Nathaniel Portz  2 , Peter Wohlmuth  3 , Shibu Mathew  2 , Feifan Ouyang  2 , Andreas Rillig  2 , Karl-Heinz Kuck  2 , Andreas Metzner  2
Affiliations

Positive impact of pulmonary vein isolation on biventricular pacing in nonresponders to cardiac resynchronization therapy

Thomas Fink et al. Heart Rhythm. 2019 Mar.

Abstract

Background: Cardiac resynchronization therapy (CRT) is less effective in patients with atrial fibrillation (AF) because of impaired ventricular CRT capture.

Objective: We investigated the effects of catheter ablation in patients with AF and previous nonresponse to CRT.

Methods: Consecutive patients with AF and CRT nonresponse who underwent catheter ablation for AF were analyzed. CRT nonresponse was defined as one of the following: (1) reduced biventricular capture <95% due to rapidly conducted AF, (2) <1 point improvement in New York Heart Association (NYHA) class after CRT implantation, or (3) insufficient increase in left ventricular ejection fraction (LVEF; ≤5%) after CRT implantation.

Results: Thirty-eight patients (8 women [21%]; mean age 68 ± 10 years; LVEF 30% ± 7%, biventricular capture 88.0% [25th, 75th percentile 75.3%, 98.5%]) underwent catheter ablation. One major and 1 minor complication occurred (1 lethal atrioesophageal fistula and 1 hemodynamically nonrelevant pericardial effusion). The Kaplan-Meier estimates for arrhythmia-free survival after single and multiple ablation procedures were 29% (95% confidence interval 16%-51%) and 67% (95% confidence interval 53%-86%) after 24 months. After a median follow-up of 817 days (25th, 75th percentile 179, 1741 days), biventricular capture and LVEF were significantly higher (median [25th, 75th percentile] 99% [96%, 99%], difference 8% [0.2%, 3.75%], P < .0001; mean 32.1% ± 9.1%, difference 2.2% ± 7.1%, P = .0225) and patients had a significantly lower functional NYHA class (28 of 37 patients with improvement of at least 1 point; P < .0001).

Conclusion: Catheter ablation of AF significantly improves CRT response in patients with heart failure and concomitant AF in terms of increased biventricular capture and LVEF and improved functional NYHA class.

Keywords: Atrial fibrillation; Cardiac resynchronization therapy; Catheter ablation; Heart failure; Pulmonary vein isolation.

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