Key result
Adding AV junction ablation to CRT cuts mortality ~29% in permanent AF and HFrEF.
Why the study?
AF correlates with poor biventricular pacing and inadequate response to CRT, which may be improved by AVJA, but the benefit in permanent AF and HFrEF patients receiving CRT needed investigation.
Does atrioventricular junction ablation reduce cardiovascular mortality and improve biventricular pacing in permanent AF and HFrEF patients receiving CRT?
Meta-Analysis (n=3,199)
Does atrioventricular junction ablation reduce cardiovascular mortality and improve biventricular pacing in permanent AF and HFrEF patients receiving CRT?
In patients with permanent AF and HFrEF receiving CRT, adding AVJA improves biventricular pacing rates, enhances reverse remodeling, and reduces cardiovascular mortality.
Answers are grounded in this paper and cite their sources.
Supports AVJA addition to CRT in permanent AF with HFrEF; confirms reduced cardiovascular mortality alongside higher biventricular pacing.
BACKGROUND: Atrial fibrillation (AF) is correlated with a poor biventricular pacing and inadequate response to cardiac resynchronization therapy (CRT). Biventricular pacing improvement can be achieved by conducting the atrioventricular junction ablation (AVJA). We aimed to investigate the benefit of AVJA for permanent AF and heart failure with reduced ejection fraction (HFrEF) patients receiving CRT. METHODS: In August 2020, a systematic review and meta-analysis study comparing CRT plus AVJA versus CRT for permanent AF and HFrEF patients was conducted. Relevant articles were identified through the electronic scientific database such as ClinicalTrials.gov, ProQuest, ScienceDirect, PubMed, and Cochrane. The pooled risk ratio (RR) and pooled mean difference (MD) were estimated. RESULTS: A total of 3199 patients from 14 cohort studies were involved in this study. Additional AVJA reduced cardiovascular mortality (RR = 0.75, 95% confidence interval [CI] = 0.61 to 0.93, P < 0.01) in permanent AF and HFrEF patients receiving CRT. Biventricular pacing rate was higher in CRT plus AVJA group (MD = 8.65%, 95% CI = 5.62 to 11.67, P < 0.01) than in CRT alone group. The reverse remodeling characterized by the reduction of left ventricular end-diastolic diameter (LVEDD) was greater in the CRT plus AVJA group (MD = -2.11 mm, 95% CI = -3.79 to -0.42, P = 0.01). CONCLUSION: In permanent AF and HFrEF patients receiving CRT, AVJA effectively increased the biventricular pacing rate. Adequate biventricular pacing rate provided a better response to the CRT marked by the greater ventricular reverse remodeling and survival from cardiovascular mortality.
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Waranugraha et al. (2021) conducted a meta-analysis in Permanent atrial fibrillation and heart failure with reduced ejection fraction (HFrEF) (n=3,199). Cardiac resynchronization therapy (CRT) plus atrioventricular junction ablation (AVJA) vs. CRT alone was evaluated on All-cause mortality (RR 0.71, 95% CI 0.52 to 0.96, p=0.03). In patients with permanent atrial fibrillation and HFrEF receiving CRT, additional atrioventricular junction ablation reduced all-cause mortality compared to CRT alone.
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