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Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?
Ana Abreu1, Mário Oliveira1, Pedro Silva Cunha1
1Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central, CHLC, Lisboa, Portugal.
Insights
Cardiac resynchronization therapy (CRT) benefits heart failure patients similarly in atrial fibrillation (AF) and sinus rhythm (SR). AF patients showed better functional response, while SR patients experienced greater left ventricular mass reduction.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF).
- The influence of atrial fibrillation (AF) on CRT effectiveness requires further investigation.
- Understanding differences in CRT response between AF and sinus rhythm (SR) patients is crucial for optimizing HF management.
Purpose of the Study:
- To compare the clinical, echocardiographic, and functional response to CRT in HF patients with AF versus SR.
- To evaluate changes in cardiac function, volumes, and exercise capacity following CRT implantation in both AF and SR groups.
Main Methods:
- Prospective study of 101 HF patients undergoing CRT implantation.
- Comparison of response rates (clinical, echocardiographic, functional) and key parameters (NYHA class, ejection fraction, volumes, mass, CPET metrics) between AF and SR groups.
- Data collected at baseline, and at 3 and 6 months post-implantation.
Main Results:
- Clinical and echocardiographic response rates were similar between AF and SR groups.
- Functional response to CRT was significantly higher in patients with AF (71% vs. 39% in SR).
- SR patients showed significant reductions in left atrial volume and left ventricular mass, while AF patients demonstrated greater improvements in exercise capacity (CPET duration, VO2max).
Conclusions:
- CRT provides comparable clinical and echocardiographic benefits for HF patients regardless of underlying rhythm (AF or SR).
- Patients with AF may experience a superior functional improvement after CRT.
- Specific reverse remodeling benefits, such as left ventricular mass reduction, are more pronounced in SR patients.
Introduction:
The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR).
Methods:
We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device.
Results:
All patients achieved ≥95% biventricular pacing, and 5.7% underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71% vs. 39% in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases.
Conclusion:
Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010).