Abstract
CRT-P Implantation and Consecutive AV-node Ablation as Rescue Therapy for Refractory Atrial Fibrillation: A Single Center Experience
Highlights
The 2013 ESC guidelines on cardiac resynchronization and cardiac pacing assess rate permanent cardiac resynchronization therapy (CRT-P) with consecutive atrioventricular node (AVN) ablation a class IIa recommendation (Level B) for patients with symptomatic permanent atrial fibrillation (AF), despite medical treatment and pulmonary vein isolation [1]
left ventricular ejection fraction (LVEF) increased from 45.17 ± 10.95% to 53.63 ± 8.33% after CRT-P implantation and AVN ablation, NYHA class decreased 2.33 ± 0.64 to 1.21 ± 0.42, EHRA score decreased from 3.00 ± 0.51 to 1.13 ± 0.34
All changes were significant (p < 0.001). In this retrospective single-centre analysis, we provide striking evidence for significant functional improvement und symptomatic benefit in patients with symptomatic and refractory atrial fibrillation with narrow QRS complex and LVEF > 35% after CRT-P implantation and AVN-ablation procedures
Summary
The 2013 ESC guidelines on cardiac resynchronization and cardiac pacing assess rate permanent cardiac resynchronization therapy (CRT-P) with consecutive atrioventricular node (AVN) ablation a class IIa recommendation (Level B) for patients with symptomatic permanent atrial fibrillation (AF), despite medical treatment and pulmonary vein isolation [1]. Several trials compared effects of right, left and biventricular pacing on left ventricular ejection fraction (LVEF), NYHA class, left atrial remodeling in patients with atrial fibrillation or patients after AVN ablation due to refractory atrial fibrillation [2,3]. A meta-analysis [10] revealed improved outcome in AF patients with CRT implantation and insufficient biventricular pacing that underwent AVN ablation compared to those who did not. The effect of CRT-P implantation and AVN-Ablation in patients with therapy refractory, symptomatic atrial fibrillation with LVEF > 35% and narrow QRS complex remains unclear. We evaluated the benefit of CRT-P implantation and consecutive AVN ablation in these patients in a real-world setting
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