Author + information
- Received May 6, 2013
- Revision received June 3, 2013
- Accepted June 5, 2013
- Published online December 1, 2013.
- Maurizio Gasparini, MD∗∗ (, )
- Christophe Leclercq, MD, PhD†,
- Maurizio Lunati, MD‡,
- Maurizio Landolina, MD§,
- Angelo Auricchio, MD‖,
- Massimo Santini, MD¶,
- Giuseppe Boriani, MD#,
- Barbara Lamp, MD∗∗,
- Alessandro Proclemer, MD††,
- Antonio Curnis, MD‡‡,
- Catherine Klersy, MD, MS§§ and
- Francisco Leyva, MD‖‖
- ∗Electrophysiology and Pacing Unit, Humanitas Research Hospital, Rozzano, Italy
- †Department of Cardiology, University Hospital Rennes, Rennes, France
- ‡Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy
- §Cardiology Department, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
- ‖Fondazione Cardiocentro Ticino, Lugano, Switzerland
- ¶Department of Cardiology, San Filippo Neri Hospital, Rome, Italy
- #Institute of Cardiology, University of Bologna and Azienda Ospedaliera Sant' Orsola-Malpighi, Bologna, Italy
- ∗∗Department of Cardiology, Heart and Diabetes Centre NRV, Bad Oeynhausen, Germany
- ††Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy
- ‡‡Cardiology Department, Spedali Civili, Brescia, Italy
- §§Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- ‖‖Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Maurizio Gasparini, Electrophysiology and Pacing Unit, Humanitas Clinical Institute, Via Manzoni 56 Rozzano, Milan 20089, Italy.
Objectives The purpose of this study is to determine whether, in patients with atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT), atrioventricular junction ablation (AVJA) is associated with a better outcome than treatment with rate-slowing drugs.
Background Different trials have demonstrated that CRT is effective in treating heart failure (HF) patients who are in sinus rhythm (SR). No trials have addressed whether CRT confers similar benefits on AF patients, with or without AVJA.
Methods The clinical outcomes of CRT for patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) were compared with those of SR patients (n = 6,046).
Results Median follow-up was 37 months. Total mortality (6.8 vs. 6.1 per 100 person-years) and cardiac mortality (4.2 vs. 4.0) were similar for patients with AF+AVJA and patients in SR (both p = NS). In contrast, the AF+drugs group had a higher total and cardiac mortality than the SR group and the AF+AVJA group (11.3 and 8.1, respectively; p < 0.001). On multivariable analysis, AF+AVJA had total mortality (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74 to 1.67) and cardiac mortality (HR: 0.88, 95% CI: 0.66 to 1.17) similar to that of the SR group, independent of known confounders. The AF+drugs group, however, had a higher total mortality (HR: 1.52, 95% CI: 1.26 to 1.82) and cardiac mortality (HR: 1.57, 95% CI: 1.27 to 1.94) than both the SR group and the AF+AVJA group (both p < 0.001).
Conclusions Long-term survival after CRT among patients with AF+AVJA is similar to that observed among patients in SR. Mortality is higher for AF patients treated with rate-slowing drugs.
- ablation of atrioventricular junction
- atrial fibrillation
- cardiac resynchronization therapy
- heart failure
Dr. Gasparini is a member of the advisory boards for Medtronic and Boston Scientific. Dr. Leclercq has received consulting fees and research grants from Medtronic, Sorin, St. Jude Medical, Biotronik, and Boston Scientific. Dr. Lunati has received consulting fees for Medtronic, Boston Scientific, St. Jude Medical, and Sorin. Dr. Auricchio has received consulting fees and research grants from Medtronic, Sorin, Biotronik, ERB Systems, Abbott, and Cordis. Dr. Santini has received consulting fees and research grants from Medtronic, St. Jude Medical, and Biotronik. Dr. Boriani has received speaker fees for Medtronic. Dr. Proclemer is on the advisory boards of Medtronic and Sorin. Dr. Curnis has received consulting fees and research grants from Medtronic, Sorin, St. Jude Medical, Biotronik, and Boston Scientific. Dr. Klersy is a statistical consultant for Medtronic. Dr. Leyva has received consulting fees and research grants from Medtronic, Sorin, St. Jude Medical, and Boston Scientific. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.
- Received May 6, 2013.
- Revision received June 3, 2013.
- Accepted June 5, 2013.
- American College of Cardiology Foundation