Atrial fibrillation attenuates the response to cardiac resynchronization therapy, while atrioventricular node ablation increases biventricular pacing and improves mortality compared to medical therapy.
This review highlights the complex interaction between atrial fibrillation and cardiac resynchronization therapy, noting that evidence for management strategies in this specific cohort is largely observational or inferred from general heart failure populations.
Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort.
Elliott et al. (Wed,) conducted a review in Atrial fibrillation and heart failure requiring cardiac resynchronization therapy. Atrioventricular node ablation or atrial fibrillation ablation vs. Medical rate control or standard care was evaluated. Atrial fibrillation attenuates the response to cardiac resynchronization therapy, while atrioventricular node ablation increases biventricular pacing and improves mortality compared to medical therapy.
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