Key result
Permanent AF shows no mortality difference versus sinus rhythm in HF patients receiving CRT-D.
Why the study?
Data on the benefit of CRT in HF patients with permanent AF have been conflicting.
Does permanent atrial fibrillation affect mortality and appropriate shocks in heart failure patients receiving CRT defibrillators compared to sinus rhythm?
Cohort (n=1,141)
Does permanent atrial fibrillation affect mortality and appropriate shocks in heart failure patients receiving CRT defibrillators compared to sinus rhythm?
In patients with CRT defibrillators, permanent AF is not associated with increased mortality compared to sinus rhythm, but AF patients with suboptimal CRT (<98%) have a significantly higher risk of appropriate shocks.
Answers are grounded in this paper and cite their sources.
Permanent AF was not associated with higher mortality in CRT-D recipients; hypothesis-generating for CRT optimization and shock risk.
AIMS: There are conflicting data on the benefit of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF). We aimed to compare patient outcomes according to the presence or absence of permanent AF at device implantation. METHODS AND RESULTS: We retrospectively analysed remote monitoring data from 1141 CRT defibrillators. Propensity score with inverse-probability weighting method was used to balance AF and sinus rhythm (SR) groups. Analysis endpoints included total mortality, appropriate defibrillation shocks, and CRT percentage. There were 229 patients (20.1%) in the AF group and 912 patients (79.9%) in the SR group. Compared with SR patients, AF patients were older (median age, 77 vs. 72 years, P < 0.001), more frequently male (82.5% vs. 75.5%, P = 0.02), and had higher heart rate (75.7 vs. 71.0 b.p.m., P < 0.001). Of the 229 AF patients, 162 (70.7%) received suboptimal CRT (<98%) and 67 (29.3%) had adequate CRT (≥98%). During a median follow-up of 24 months, total mortality did not differ between AF and SR groups (propensity-score-weighted hazard ratio, HR 1.32 [95% confidence interval, 0.82-2.15], P = 0.25). The risk of appropriate shocks was significantly higher in the AF group with <98% CRT than in the SR group (weighted-HR, 1.99 [1.21-3.26], P = 0.006) and was similar in the AF group with ≥98% CRT versus the SR group (1.29 [0.66-2.53], P = 0.45). During follow-up, sinus rhythm was recovered in 23 patients in the AF group (10%) after a median time of 106 (42-256) days. The rate of sinus rhythm recovery in the AF group was 4.5 (95% CI, 2.8-6.7) per 100 patient-years; the rate of permanent AF occurrence in the SR group was 2.5 (95% CI, 1.9-3.3) per 100 patient-years. CONCLUSIONS: Although mortality was similar across patient groups, patients with permanent AF and suboptimal CRT had twofold higher risk of appropriate shocks than SR patients or AF patients with CRT ≥ 98%.
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Rapacciuolo et al. (2021) conducted a cohort in Heart failure (n=1,141). Permanent atrial fibrillation vs. Sinus rhythm was evaluated on Total mortality (HR 1.32, 95% CI 0.82-2.15, p=0.25). In heart failure patients receiving CRT defibrillators, total mortality did not differ between those with permanent atrial fibrillation and sinus rhythm.
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