Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 19;6(1):e000937.
doi: 10.1136/openhrt-2018-000937. eCollection 2019.

Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies

Usman Mustafa #  1   2 , Jessica Atkins #  1   2   3 , George Mina  1   2   3 , Desiree Dawson  1   2   3 , Catherine Vanchiere  1   2   3 , Narendra Duddyala  1   2   3 , Ryan Jones  1   2   3 , Pratap Reddy  1   2   3 , Paari Dominic  1   2   3
Affiliations

Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies

Usman Mustafa et al. Open Heart. .

Abstract

Background: Cardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF).

Methods and results: Literature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).

Conclusion: The results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.

Keywords: atrioventricular junction ablation; biventricular pacing; ejection fraction; implanted cardioverter defibrillator.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Forest plot comparing mortality in patients with AF with CRT versus ICD/medical therapy. (B) Forest plot comparing all-cause mortality (ACM) in patients with heart failure (HF) with CRT-AF versus CRT-NSR. AF, atrial fibrillation; CRT, cardiac resynchronisation therapy; ICD, internal cardioverter defibrillator; NSR, normal sinus rhythm.
Figure 2
Figure 2
Forest plot of composite endpoint in patients with AF with CRT versus ICD/GDMT. Forest plot of cardiovascular mortality in CRT patients with AF versus NSR. AF, atrial fibrillation; CRT, cardiac resynchronisation therapy; GDMT, goal directed medical therapy; ICD, internal cardioverter defibrillator; NSR, normal sinus rhythm.
Figure 3
Figure 3
Forest plot comparing all-cause mortality (ACM) in CRT-AF versus CRT-NSR in patients based on atrioventricular junction ablation (AVJA) status. AF, atrial fibrillation; CRT, cardiac resynchronisation therapy; NSR, normal sinus rhythm.
Figure 4
Figure 4
Forest plot of all-cause mortality (ACM) in CRT patient with AF comparing atrioventricular junction ablation (AVJA) versus no AVJA. AF, atrial fibrillation; CRT, cardiac resynchronisation therapy; NSR, normal sinus rhythm.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wasywich CA, Pope AJ, Somaratne J, et al. . Atrial fibrillation and the risk of death in patients with heart failure: a literature-based meta-analysis. Intern Med J 2010;40:347–56. 10.1111/j.1445-5994.2009.01991.x - DOI - PubMed
    1. Cheng A, Landman SR, Stadler RW. Reasons for loss of cardiac resynchronization therapy pacing: insights from 32 844 patients. Circ Arrhythm Electrophysiol 2012;5:884–8. 10.1161/CIRCEP.112.973776 - DOI - PubMed
    1. Boriani G, Gasparini M, Landolina M, et al. . Incidence and clinical relevance of uncontrolled ventricular rate during atrial fibrillation in heart failure patients treated with cardiac resynchronization therapy. Eur J Heart Fail 2011;13:868–76. 10.1093/eurjhf/hfr046 - DOI - PubMed
    1. Tolosana JM, Hernandez Madrid A, Brugada J, et al. . Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study). Am J Cardiol 2008;102:444–9. 10.1016/j.amjcard.2008.04.008 - DOI - PubMed
    1. Gasparini M, Leclercq C, Lunati M, et al. . Cardiac resynchronization therapy in patients with atrial fibrillation: the certify study (cardiac resynchronization therapy in atrial fibrillation patients multinational registry). JACC Heart Fail 2013;1:500–7. 10.1016/j.jchf.2013.06.003 - DOI - PubMed

Publication types