Cardiac Resynchronization Therapy and Atrial Fibrillation.
Ganesh S Kamath1, Jonathan S Steinberg1
1Al-Sabah Arrhythmia Institute and Division of Cardiology, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians & Surgeons, New York, NY USA.
Journal of Atrial Fibrillation
|May 13, 2017
Summary
Cardiac resynchronization therapy (CRT) benefits heart failure (HF) patients with atrial fibrillation (AF). AV junction ablation with pacing can optimize CRT by ensuring biventricular capture, overcoming AF interference.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is vital for end-stage heart failure (HF).
- Atrial fibrillation (AF) complicates 15-50% of HF cases, worsening outcomes.
- Observational studies suggest CRT benefits AF patients similarly to those in sinus rhythm (SR).
Purpose of the Study:
- To explore strategies for optimizing CRT delivery in HF patients with AF.
- To address interference with biventricular (BiV) capture caused by conducted beats in AF patients.
Main Methods:
- Discusses Atrioventricular Junction (AVJ) ablation with permanent pacing to ensure complete BiV capture.
- Considers catheter ablation of AF as an alternative to antiarrhythmic drugs for maintaining SR.
- Highlights the need for randomized trials comparing these approaches.
Main Results:
- AVJ ablation with pacing eliminates conducted beat interference, enabling complete BiV capture.
- Catheter ablation offers an alternative to pharmacologic therapy for AF management in HF.
- Current evidence is primarily from observational studies, necessitating further investigation.
Conclusions:
- Optimizing CRT in HF patients with AF requires strategies to manage conducted beats.
- AVJ ablation and catheter ablation are potential methods to improve CRT efficacy.
- Randomized trials are essential to compare catheter ablation, AVJ ablation, and pharmacologic therapy.
Related Concept Videos
01:29Disturbances in Heart Rhythm
3.4K
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
3.4K
01:25Dysrhythmias VI: Management of Dysrhythmias
547
Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
547
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
716
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
716
01:23Cardiopulmonary Resuscitation III: AED Use
931
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
931
01:22Heart Failure VI: Adjunct Therapies
477
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
477
01:30Cardiomyopathy II: Dilated Cardiomyopathy
677
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
677