Impact of atrioventricular junction ablation and CRT‐D on long‐term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation, and narrow QRS: Results of a propensity‐matched analysis

Pietro Palmisano; Matteo Ziacchi; Ernesto Ammendola; Gabriele Dell’Era; Federico Guerra; Paolo Donateo; Giuseppe Del Giorno; Mattia Laffi; Giovanni Coluccia; Lorenzo Bartoli; Germano Gaggioli; Angelo Carbone; Jacopo Sénès; Antonio Dello Russo; Giuseppe Patti; Gerardo Nigro; Mauro Biffi; Michele Accogli

doi:10.1111/jce.15645

Why the study?

To compare mortality in patients with HFrEF and permanent AF treated with AVJA plus CRT against a contemporary cohort of similar patients in sinus rhythm.

Does AVJA plus CRT improve all-cause mortality in patients with HFrEF, narrow QRS, and permanent AF compared to ICD alone in similar patients in sinus rhythm?

Key Points

To evaluate whether atrioventricular junction ablation combined with cardiac resynchronization therapy defibrillator yields long-term survival comparable to matched sinus rhythm controls in patients with reduced ejection fraction and permanent atrial fibrillation.
Prospective, multicenter, observational study enrolling 824 patients with heart failure with reduced ejection fraction and narrow QRS.
Compared patients undergoing atrioventricular junction ablation plus cardiac resynchronization therapy defibrillator against contemporary sinus rhythm controls receiving an implantable cardioverter-defibrillator alone.
Conducted 1:1 propensity score matching yielding 107 matched pairs with a median follow-up of 52 months.
All-cause mortality did not differ significantly between patients receiving ablation plus resynchronization therapy and matched sinus rhythm controls (p = .434).
Ablation plus resynchronization was associated with significantly lower mortality compared to control patients with a history of paroxysmal or persistent atrial fibrillation (n = 45, p = .020).
Mortality rates were similar between the intervention cohort and control patients without a history of atrial fibrillation (n = 62, p = .459).

Structured PICO

Does AVJA plus CRT improve all-cause mortality in patients with HFrEF, narrow QRS, and permanent AF compared to ICD alone in similar patients in sinus rhythm?

P

Population

824 patients with heart failure with reduced ejection fraction (HFrEF), narrow QRS, and permanent atrial fibrillation (PEAF) with uncontrolled ventricular rate (propensity matching yielded 107 matched pairs)

I

Intervention

Atrio-ventricular junction ablation (AVJA) and implantable cardioverter-defibrillator (ICD) combined with cardiac resynchronization therapy (CRT) implantation

C

Comparator

Contemporary cohort of patients in sinus rhythm (SR) undergoing ICD implantation (not combined with CRT) for HFrEF and narrow QRS

O

Outcome

All-cause mortalityhard clinical

In patients with HFrEF, narrow QRS, and permanent AF, AVJA plus CRT results in similar long-term mortality compared to a matched cohort of patients in sinus rhythm receiving an ICD.

Implication

Comparable mortality with AVJA plus CRT versus sinus-rhythm ICD; leaves open randomized trials versus rate control in narrow-QRS permanent AF.

Discussion

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Cite This Study

Palmisano et al. (2022) studied this question.

synapsesocial.com/papers/69ffcb517e61d2a3f0c22f95 https://doi.org/10.1111/jce.15645

Topics

HFrEF treatment

Heart failure

Atrial fibrillation

Persistent AF management

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Impact of atrioventricular junction ablation and CRT‐D on long‐term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation, and narrow QRS: Results of a propensity‐matched analysis

Key Points

Structured PICO

Implication

Discussion

Cite This Study

Topics

Impact of atrioventricular junction ablation and CRT‐D on long‐term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation, and narrow QRS: Results of a propensity‐matched analysis

Key Points

Structured PICO

Implication

Discussion

Cite This Study

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