September 30, 2011
Cardiac Resynchronization Therapy and Atrial Fibrillation.
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Key result
Cardiac resynchronization therapy offers substantial symptomatic and mortality benefits in heart failure patients with atrial fibrillation, similar to those in sinus rhythm, provided complete biventricular capture is achieved.
Why the study?
Does cardiac resynchronization therapy combined with AV junction ablation or catheter ablation improve clinical outcomes in patients with heart failure and atrial fibrillation?
Population
Patients with end-stage heart failure (HF) complicated by atrial fibrillation (AF)
Comparison
Cardiac resynchronization therapy combined with… vs CRT with pharmacologic rate control or patients…
Design
Review
Authors
Discussion
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Implication
Requires ensured biventricular capture for CRT benefit in HF-AF; leaves open optimal ablation strategies.
Structured PICO
Does cardiac resynchronization therapy combined with AV junction ablation or catheter ablation improve clinical outcomes in patients with heart failure and atrial fibrillation?
P
Population
Patients with end-stage heart failure (HF) complicated by atrial fibrillation (AF)
I
Intervention
Cardiac resynchronization therapy (CRT) combined with atrioventricular junction (AVJ) ablation or catheter ablation
C
Comparator
CRT with pharmacologic rate control or patients in sinus rhythm
O
Outcome
Clinical response, biventricular capture, and survival
In patients with heart failure and atrial fibrillation undergoing CRT, achieving complete biventricular capture is essential and may necessitate AV junction ablation or catheter ablation to match the benefits seen in patients in sinus rhythm.
Limitations
- Data for efficacy of CRT in AF patients has been largely obtained from nonrandomized studies with small numbers of patients.
- Lack of large randomized clinical trials comparing catheter ablation, AVJ ablation, and pharmacologic therapy.
- Lack of large randomized clinical trials comparing catheter ablation, AVJ ablation, and pharmacologic therapy
Cite This Study
Kamath et al. (2011) conducted a review in Heart failure and atrial fibrillation. Cardiac Resynchronization Therapy (CRT) was evaluated. Cardiac resynchronization therapy offers substantial symptomatic and mortality benefits in heart failure patients with atrial fibrillation, similar to those in sinus rhythm, provided complete biventricular capture is achieved.
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