open access

Vol 16, No 1 (2009)
Review articles
Published online: 2008-11-28
Submitted: 2013-01-14
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Cardiac resynchronization therapy and atrial fibrillation

Ganesh S. Kamath, Jonathan S. Steinberg
Cardiol J 2009;16(1):4-10.

open access

Vol 16, No 1 (2009)
Review articles
Published online: 2008-11-28
Submitted: 2013-01-14

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), associated with worsened outcomes. The presence of AF may interfere with optimal delivery of CRT due to competition with biventricular (BiV) capture by conducted beats. Pacing algorithms in newer devices may not ensure consistent CRT delivery during periods of rapid ventricular rates. Atrioventricular junction ablation with permanent pacing eliminates interference by conducted beats and provides complete BiV capture and is associated with improved outcomes. Catheter ablation of AF is another promising alternative to maintain sinus rhythm in patients with AF and HF. However, the optimal indications for CRT delivery for patients in this complex cohort remain to be assessed in randomized clinical trials.

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), associated with worsened outcomes. The presence of AF may interfere with optimal delivery of CRT due to competition with biventricular (BiV) capture by conducted beats. Pacing algorithms in newer devices may not ensure consistent CRT delivery during periods of rapid ventricular rates. Atrioventricular junction ablation with permanent pacing eliminates interference by conducted beats and provides complete BiV capture and is associated with improved outcomes. Catheter ablation of AF is another promising alternative to maintain sinus rhythm in patients with AF and HF. However, the optimal indications for CRT delivery for patients in this complex cohort remain to be assessed in randomized clinical trials.
Get Citation

Keywords

atrial fibrillation; cardiac resynchronization therapy

About this article
Title

Cardiac resynchronization therapy and atrial fibrillation

Journal

Cardiology Journal

Issue

Vol 16, No 1 (2009)

Pages

4-10

Published online

2008-11-28

Bibliographic record

Cardiol J 2009;16(1):4-10.

Keywords

atrial fibrillation
cardiac resynchronization therapy

Authors

Ganesh S. Kamath
Jonathan S. Steinberg

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