Cardiac Resynchronisation Therapy in Heart Failure Patients with Atrial Fibrillation

Abstract

Cardiac resynchronisation therapy (CRT) is an important device-based, non-pharmacological approach that has been shown to improve left ventricular (LV) function and reduce both morbidity and mortality rates in selected patients affected by advanced heart failure (HF), with New York Heart Association (NYHA) functional class III–IV, ejection fraction (EF) ≤35%, QRS duration ≥120ms and on optimal medical therapy. Patients with atrial fibrillation (AF), who constitute an important subgroup of HF patients, are nowadays considered eligible for receiving CRT as described in the latest European Society of Cardiology (ESC) and American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines, with some relevant differences in terms of how to manage the interference of natural rhythm and biventricular pacing. In this article, the authors explain how AF may interfere with adequate CRT delivery and how to manage different AF burdens, trying to obtain the best effects of CRT in AF patients.