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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Clinical Implications of Device-Detected Atrial Fibrillation in Cardiac Resynchronization Therapy

Minjae Yoon1,2, Jaewon Oh1, Kyeong-Hyeon Chun3

  • 1Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.

Korean Circulation Journal
|June 4, 2023
PubMed

Insights

Device-detected atrial fibrillation (AF) in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT) is linked to reduced optimal biventricular pacing and poorer clinical outcomes compared to patients without AF.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Heart Failure Management

Background:

  • Atrial fibrillation (AF) diminishes the effectiveness of cardiac resynchronization therapy (CRT) compared to sinus rhythm (SR).
  • Optimal biventricular (BiV) pacing is crucial for CRT success, but AF can impede it, negatively impacting patient outcomes.
  • Investigating the impact of device-detected AF on BiV pacing and clinical outcomes in heart failure (HF) patients undergoing CRT is essential.

Purpose of the Study:

  • To evaluate the association between device-detected AF and optimal BiV pacing in HF patients treated with CRT.
  • To determine the effect of device-detected AF on clinical outcomes, including heart failure hospitalizations and mortality.
  • To compare outcomes between patients with and without device-detected AF post-CRT implantation.

Main Methods:

  • Retrospective analysis of 174 patients who received CRT between 2012 and 2019.
  • Definition of optimal BiV pacing as ≥98% and device-detected AF as atrial high-rate episodes ≥180 bpm for >6 minutes.
  • Stratification of patients without pre-existing AF into device-detected AF and no-AF groups for comparison.

Main Results:

  • Among 120 patients without pre-existing AF, 15.8% developed device-detected AF.
  • Optimal BiV pacing was significantly lower in the device-detected AF group (42.1%) versus the no-AF group (75.2%).
  • The device-detected AF group experienced higher rates of HF hospitalization, cardiovascular death, and all-cause death.

Conclusions:

  • Device-detected AF in HF patients with CRT is associated with suboptimal BiV pacing.
  • This suboptimal pacing in the presence of device-detected AF correlates with worse clinical outcomes.
  • These findings highlight the importance of monitoring and managing AF in CRT recipients.
Abstract

Keywords:
Atrial fibrillationCardiac resynchronization therapyHeart failure

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