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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

A strategy to achieve CRT response in permanent atrial fibrillation without obligatory atrioventricular node ablation

Frank Himmel1, Michael Reppel, Kai Mortensen

  • 1Medizinische Klinik II, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany. Frank.Himmel@uk-sh.de

Pacing and Clinical Electrophysiology : PACE
|June 2, 2012
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves heart failure outcomes in patients with permanent atrial fibrillation (AF). Atrioventricular node (AVN) ablation may not be necessary for all AF patients receiving CRT.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is effective for severe heart failure with wide QRS, especially in sinus rhythm (SR).
  • The role of atrioventricular node (AVN) ablation in CRT patients with permanent atrial fibrillation (AF) remains debated.
  • This study evaluates the benefits of CRT in permanent AF patients, with and without AVN ablation.

Purpose of the Study:

  • To assess the efficacy of CRT in patients with permanent atrial fibrillation (AF).
  • To compare outcomes of CRT in permanent AF patients who underwent AVN ablation versus those managed with pharmacological rate control.
  • To determine if AVN ablation is essential for optimal CRT outcomes in permanent AF.

Main Methods:

  • Assessed New York Heart Association classification, QRS duration, and echocardiographic parameters pre- and post-CRT (12 ± 3 months follow-up).
  • Studied 230 patients in SR and 46 patients with permanent AF (duration 2.1 ± 0.5 years).
  • Performed AVN ablation only in AF patients with inadequate pharmacological rate control (≤80% ventricular stimulation).

Main Results:

  • Biventricular pacing improved functional status, left ventricular ejection fraction, and dimensions similarly across all groups.
  • Fifteen AF patients underwent AVN ablation.
  • Biventricular stimulation percentage was comparable between SR, pharmacologically treated AF, and AVN ablated AF patients, with no impact on outcomes.

Conclusions:

  • Atrioventricular node (AVN) ablation may not be a mandatory strategy for all patients with permanent atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT).
  • CRT provides comparable benefits in functional status and cardiac remodeling regardless of AVN ablation in permanent AF patients.
Abstract

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