Conclusion The results of our meta- analysis suggest that AF was associated with decreased CRT benefits in patients with HF .
CRT , however , benefits patients with AF with AVJ ablation
Background Cardiac resynchronisation therapy ( CRT ) is beneficial in selected patients with heart failure ( HF ) in normal sinus rhythm ( NSR ) .
Cardiac-resynchronization therapy for mild-to-moderate heart failure.
BACKGROUND Cardiac-resynchronization therapy ( CRT ) benefits patients with left ventricular systolic dysfunction and a wide QRS complex . Most of these patients are c and i date s for an implantable cardioverter-defibrillator ( ICD ) . We evaluated whether adding CRT to an ICD and optimal medical therapy might reduce mortality and morbidity among such patients . METHODS We r and omly assigned patients with New York Heart Association ( NYHA ) class II or III heart failure , a left ventricular ejection fraction of 30 % or less , and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD alone or an ICD plus CRT . The primary outcome was death from any cause or hospitalization for heart failure . RESULTS We followed 1798 patients for a mean of 40 months . The primary outcome occurred in 297 of 894 patients ( 33.2 % ) in the ICD-CRT group and 364 of 904 patients ( 40.3 % ) in the ICD group ( hazard ratio in the ICD-CRT group , 0.75 ; 95 % confidence interval [ CI ] , 0.64 to 0.87 ; P<0.001 ) . In the ICD-CRT group , 186 patients died , as compared with 236 in the ICD group ( hazard ratio , 0.75 ; 95 % CI , 0.62 to 0.91 ; P = 0.003 ) , and 174 patients were hospitalized for heart failure , as compared with 236 in the ICD group ( hazard ratio , 0.68 ; 95 % CI , 0.56 to 0.83 ; P<0.001 ) . However , at 30 days after device implantation , adverse events had occurred in 124 patients in the ICD-CRT group , as compared with 58 in the ICD group ( P<0.001 ) . CONCLUSIONS Among patients with NYHA class II or III heart failure , a wide QRS complex , and left ventricular systolic dysfunction , the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure . This improvement was accompanied by more adverse events . ( Funded by the Canadian Institutes of Health Research and Medtronic of Canada ; Clinical Trials.gov number , NCT00251251 . )
Conclusion The results of our meta- analysis suggest that AF was associated with decreased CRT benefits in patients with HF .
CRT , however , benefits patients with AF with AVJ ablation
Background Cardiac resynchronisation therapy ( CRT ) is beneficial in selected patients with heart failure ( HF ) in normal sinus rhythm ( NSR ) .