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September 12, 2021ESC Heart FailureOpen Access

Cardiac Resynchronization Therapy Defibrillators in Patients with Permanent Atrial Fibrillation

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Key result

Permanent AF shows no mortality difference versus sinus rhythm in HF patients receiving CRT-D.

  • HR 1.32
  • 95% CI 0.82-2.15
  • P=0.25
  • n=1,141

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?

Population

1141 patients with CRT defibrillators (229 with permanent AF, 912 in sinus rhythm)

Comparison

Permanent AF vs sinus rhythm at device implantation

Design

Retrospective propensity score inverse-probability weighted cohort study

Follow-up

Median 24 months

Authors

ARAntonio RapacciuoloSISaverio IacopinoADAntonio D’Onofrio

Discussion

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Member takes

Overview

Permanent AF was not associated with higher mortality in CRT-D recipients; hypothesis-generating for CRT optimization and shock risk.

Study Design

Type

Cohort (n=1,141)

Structured PICO

Does permanent atrial fibrillation affect mortality and appropriate shocks in heart failure patients receiving CRT defibrillators compared to sinus rhythm?

P
Population
1,141 heart failure patients with cardiac resynchronization therapy (CRT) defibrillators (229 with permanent atrial fibrillation, 912 with sinus rhythm)
I
Intervention
Permanent atrial fibrillation at device implantation
C
Comparator
Sinus rhythm at device implantation
O
Outcome
Total mortalityhard clinical

Main Result

Effect estimate: HR 1.32 (95% CI 0.82-2.15)

p-value: p=0.25

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.

Cite This Study

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 (HR 1.32; 95% CI 0.82-2.15; P=0.25).

synapsesocial.com/papers/6a08aba67de338f10b10e752https://doi.org/10.1002/ehf2.13599
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiac Resynchronization Therapy in Patients with Atrial Fibrillation: A 2‐Year Follow‐Up Study2013 · 8 citations
  2. 2Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?2017 · 4 citations
  3. 3Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation2008 · 265 citations
  4. 4Long-term outcomes of cardiac resynchronization therapy are worse in patients who require atrioventricular junction ablation for atrial fibrillation than in those with sinus rhythm2013 · 15 citations
  5. 5Probability of sinus rhythm conversion and maintenance in cardiac resynchronization therapy patients with atrial fibrillation during 5‐year follow‐up2020 · 2 citations