Abstract
It remains unclear as to whether cardiac resynchronization therapy (CRT) would be as effective in patients with atrial fibrillation (AF) accompanied by slow ventricular response (AF-SVR, < 60 beats/min) as in those with sinus rhythm (SR). Echocardiographic reverse remodeling was compared between AF-SVR patients (n = 17) and those with SR (n = 88) at six months and 12 months after CRT treatment. We also evaluated the changes in QRS duration; New York Heart Association (NYHA) functional class; and long-term composite clinical outcomes including cardiac death, heart transplantation, and heart failure (HF)-related hospitalization. Left ventricular pacing sites and biventricular pacing percentages were not significantly different between the AF-SVR and SR groups. However, heart rate increase after CRT was significantly greater in the AF-SVR group than in the SR group (P < 0.001). At six and 12 months postoperation, both groups showed a comparable improvement in NYHA class; QRS narrowing; and echocardiographic variables including left ventricular end-systolic volume, left ventricular ejection fraction, and left atrial volume index. Over the median follow-up duration of 1.6 (interquartile range: 0.8–2.2) years, no significant between-group differences were observed regarding the rates of long-term composite clinical events (35% versus 24%; hazard ratio: 1.71; 95% confidence interval: 0.23–12.48; P = 0.60). CRT implantation provided comparable beneficial effects for patients with AF-SVR as compared with those with SR, by correcting electrical dyssynchrony and increasing biventricular pacing rate, in terms of QRS narrowing, symptom improvement, ventricular reverse remodeling, and long-term clinical outcomes.
Highlights
Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms and reduces all-cause mortality in patients with a prolonged QRS duration [1]
A total of 105 patients were included into our analysis and divided into the following two groups based on their baseline rhythm prior to CRT implantation: the atrial fibrillation (AF)-slow ventricular response (SVR) group and the sinus rhythm (SR) group (n = 88)
We considered the following covariates in the multivariate analysis that were potential confounders: age, sex, New York Heart Association (NYHA) functional class, availability of back-up defibrillation with implanted device, LVEF, change in heart rate (HR), and QRS duration
Summary
Cardiac resynchronization therapy (CRT) improves heart failure (HF) symptoms and reduces all-cause mortality in patients with a prolonged QRS duration [1]. CRT improves quality of life and induces left ventricular (LV) reverse remodeling, especially in HF patients with. CRT for AF patients with slow ventricular response sinus rhythm (SR) [2,3]. The majority of randomized controlled trials conducted to date only included patients with SR and excluded those with atrial fibrillation (AF). Patients with HF are more likely to develop AF as compared with the general population, and AF incidence increases with the severity of HF [4,5]. Up to 30% of HF patients with New York Heart Association (NYHA) functional classes III to IV develop AF [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
