Atrial fibrillation in cardiac resynchronization therapy
Mark K Elliott1,2, Vishal S Mehta1,2, Dejana Martic2
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Heart Rhythm O2
|January 6, 2022
Summary
Atrial fibrillation (AF) complicates cardiac resynchronization therapy (CRT) response in heart failure patients. This review explores AF management strategies alongside CRT for improved outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Up to 40% of patients receiving cardiac resynchronization therapy (CRT) have atrial fibrillation (AF), yet they were excluded from major clinical trials.
- AF can reduce CRT effectiveness by decreasing biventricular pacing and atrioventricular synchrony.
- Cardiac remodeling from CRT may also impact AF progression.
Purpose of the Study:
- To review the complex interactions between AF, heart failure, and CRT.
- To discuss current evidence for managing AF in patients undergoing CRT.
Main Methods:
- Literature review of studies on AF, heart failure, and CRT.
- Analysis of management strategies including rate and rhythm control, and AF catheter ablation.
- Evaluation of evidence from observational and randomized trials.
Main Results:
- AF significantly attenuates CRT response due to reduced pacing and loss of synchrony.
- CRT may influence the progression of AF through cardiac remodeling.
- Management options for AF in CRT patients include rate control, rhythm control, and catheter ablation.
Conclusions:
- Managing AF in CRT patients is complex due to limited direct evidence.
- Current treatment strategies for AF in this cohort are largely based on observational data or extrapolated from broader heart failure populations.
- Further research is needed to optimize AF management in patients receiving CRT.
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