open access

Vol 21, No 3 (2014)
Original articles
Published online: 2014-06-09
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Long-term outcomes of cardiac resynchronization therapy are worse in patients who require atrioventricular junction ablation for atrial fibrillation than in those with sinus rhythm

Ewa Jędrzejczyk-Patej, Radosław Lenarczyk, Patrycja Pruszkowska, Oskar Kowalski, Michał Mazurek, Adam Sokal, Joanna Boidol, Aleksandra Woźniak, Sławomir Pluta, Mariola Szulik, Agnieszka Liberska, Zbigniew Kalarus
DOI: 10.5603/CJ.a2013.0110
·
Cardiol J 2014;21(3):309-315.

open access

Vol 21, No 3 (2014)
Original articles
Published online: 2014-06-09

Abstract

Background: The aim of the study was to assess the impact of atrial fibrillation (AF) with and without the need for atrioventricular junction (AVJ) ablation on outcomes in patients undergoing cardiac resynchronization therapy (CRT).

Methods: A single center cohort of 200 consecutive CRT patients was divided into three groups: 1) AF with CRT pacing < 95% in which AVJ ablation was performed (AF-ABL, n = 40; 20%), 2) AF without the need for AVJ ablation (AF-non ABL, n = 40; 20%), 3) sinus rhythm (SR, n = 120; 60%). All patients were assessed before CRT implantation and at 6-month follow-up. Positive clinical response to CRT was considered alive status without the need for heart transplantation and improvement ≥ 1 NYHA after 6 months. The comparative analysis among all study groups with respect to response-rate and long-term survival was performed.

Results: The 6-month response-rate in both AF-ABL and AF-nonABL was significantly lower than in SR (52.5 and 50 vs.77.5%, respectively; both p < 0.017), though there were no differences in baseline characteristics among study groups apart from higher baseline NT-proBNP levels in AF-ABL. However, after adjustment for this confounder, and despite optimal CRT pacing burden in study groups, the remote all-cause mortality during median follow-up of 36.1 months was significantly higher in AF-ABL than in SR (adjusted HR = 2.57, 95% CI 1.09–6.02, p = 0.03). What is more, no difference in long-term survival between SR and AF-nonABL was observed.

Conclusions: Despite the improvement of CRT pacing burden and thus response-rate up to the level of AF subjects without the need for ablation, the long-term survival of AF patients requiring AVJ ablation remains still worse than in SR.

Abstract

Background: The aim of the study was to assess the impact of atrial fibrillation (AF) with and without the need for atrioventricular junction (AVJ) ablation on outcomes in patients undergoing cardiac resynchronization therapy (CRT).

Methods: A single center cohort of 200 consecutive CRT patients was divided into three groups: 1) AF with CRT pacing < 95% in which AVJ ablation was performed (AF-ABL, n = 40; 20%), 2) AF without the need for AVJ ablation (AF-non ABL, n = 40; 20%), 3) sinus rhythm (SR, n = 120; 60%). All patients were assessed before CRT implantation and at 6-month follow-up. Positive clinical response to CRT was considered alive status without the need for heart transplantation and improvement ≥ 1 NYHA after 6 months. The comparative analysis among all study groups with respect to response-rate and long-term survival was performed.

Results: The 6-month response-rate in both AF-ABL and AF-nonABL was significantly lower than in SR (52.5 and 50 vs.77.5%, respectively; both p < 0.017), though there were no differences in baseline characteristics among study groups apart from higher baseline NT-proBNP levels in AF-ABL. However, after adjustment for this confounder, and despite optimal CRT pacing burden in study groups, the remote all-cause mortality during median follow-up of 36.1 months was significantly higher in AF-ABL than in SR (adjusted HR = 2.57, 95% CI 1.09–6.02, p = 0.03). What is more, no difference in long-term survival between SR and AF-nonABL was observed.

Conclusions: Despite the improvement of CRT pacing burden and thus response-rate up to the level of AF subjects without the need for ablation, the long-term survival of AF patients requiring AVJ ablation remains still worse than in SR.

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Keywords

cardiac resynchronization, atrial fibrillation, heart failure, junction ablation

About this article
Title

Long-term outcomes of cardiac resynchronization therapy are worse in patients who require atrioventricular junction ablation for atrial fibrillation than in those with sinus rhythm

Journal

Cardiology Journal

Issue

Vol 21, No 3 (2014)

Pages

309-315

Published online

2014-06-09

DOI

10.5603/CJ.a2013.0110

Bibliographic record

Cardiol J 2014;21(3):309-315.

Keywords

cardiac resynchronization
atrial fibrillation
heart failure
junction ablation

Authors

Ewa Jędrzejczyk-Patej
Radosław Lenarczyk
Patrycja Pruszkowska
Oskar Kowalski
Michał Mazurek
Adam Sokal
Joanna Boidol
Aleksandra Woźniak
Sławomir Pluta
Mariola Szulik
Agnieszka Liberska
Zbigniew Kalarus

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