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
. 2024 Oct 10.
doi: 10.1007/s00392-024-02541-z. Online ahead of print.

Rhythm and rate control strategies in patients with long-standing persistent atrial fibrillation treated with cardiac resynchronization: the results of the randomized Pilot-CRAfT study

Jan B Ciszewski  1 , Mateusz Tajstra  2 , Ilona Kowalik  3 , Aleksander Maciąg  4 , Tomasz Chwyczko  5   6 , Agnieszka Jankowska  3 , Edyta Smolis-Bąk  5 , Bohdan Firek  5 , Dariusz Zając  4 , Jarosław Karwowski  3   7 , Hanna Szwed  3 , Mariusz Pytkowski  4 , Mariusz Gąsior  2 , Maciej Sterliński  8
Affiliations

Rhythm and rate control strategies in patients with long-standing persistent atrial fibrillation treated with cardiac resynchronization: the results of the randomized Pilot-CRAfT study

Jan B Ciszewski et al. Clin Res Cardiol. .

Abstract

Background: Atrial fibrillation (AF) is common in cardiac resynchronization therapy (CRT) recipients. It is a marker of impaired CRT response mainly mediated by the reduction of effectively captured biventricular paced beats (BiVp). There are no randomized trials comparing strategies to maintain high BiVp percentage.

Objective: To compare the efficacy of rhythm vs rate control strategies in CRT recipients with long-standing persistent AF.

Methods: We performed a randomized trial including CRT recipients with persistent AF resulting in low BiVp%. All patients received amiodarone, the rhythm control group received external electrical cardioversion (EC), and the rate control group received atrioventricular node ablation, if needed. The primary end-point was 12-month BiVp% (NCT).

Results: 43 patients were included in the analysis. The mean age was 68.4 (SD: ± 8.3) years and the mean BiVp% 82.4% ± 9.7%. AF lasted 25 ± 19 months. The mean baseline left ventricular ejection fraction (LVEF), left atrium area, and the maximal oxygen uptake (VO2max) were: 30 ± 8%, 33 ± 7 cm2, and 14 ± 5 mL/(kg*min), respectively. The EC success rate was 58%. 38% patients remained in sinus rhythm (SR) after 12 months. BiVp% increased similarly in both arms reaching 99% [95% CI 97.3-99.8] and 98% [94.0-99.0], P = 0.14 in rhythm and rate control groups, respectively. LVEF raised significantly only in the rhythm control group (ΔLVEF 4.1 (± 7.3), P = 0,018) which was driven by the patients who maintained SR. No differences in VO2max, QoL, clinical and safety end-points were observed.

Conclusion: Despite comparable BiVp% in both groups, only restoration of SR led to improved left ventricular ejection fraction in CRT patients with long-standing AF.

Trial registration: NCT01850277 registered on 22/04/2013.

Keywords: Atrial fibrillation; Biventricular paced beats percentage; Cardiac resynchronization; Electrical cardioversion; Heart failure.

PubMed Disclaimer

References

    1. Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J et al (2013) An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34(46):3547–3556 - DOI - PubMed - PMC
    1. Healey JS, Hohnloser SH, Exner DV, Birnie DH, Parkash R, Connolly SJ et al (2012) Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT). Circ Heart Fail 5(5):566–570 - DOI - PubMed
    1. Kalscheur MM, Saxon LA, Lee BK, Steinberg JS, Mei C, Buhr KA et al (2017) Outcomes of cardiac resynchronization therapy in patients with intermittent atrial fibrillation or atrial flutter in the COMPANION trial. Heart Rhythm 14(6):858–865 - DOI - PubMed
    1. Khazanie P, Greiner MA, Al-Khatib SM, Piccini JP, Turakhia MP, Varosy PD et al (2016) Comparative effectiveness of cardiac resynchronization therapy among patients with heart failure and atrial fibrillation: findings from the national cardiovascular data registry’s implantable cardioverter-defibrillator registry. Circ Heart Fail. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002324 - DOI - PubMed - PMC
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128(16):e240-327 - PubMed

Associated data

LinkOut - more resources