AV nodal ablation was associated with a substantial reduction in all-cause mortality and cardiovascular mortality and with improvements in New York Heart Association functional class compared with medical therapy in CRT-AF patients .
OBJECTIVES The aim of this study was to systematic ally review the medical literature to evaluate the impact of AV nodal ablation in patients with heart failure and coexistent atrial fibrillation ( AF ) receiving cardiac resynchronization therapy ( CRT ) .
BACKGROUND CRT has a substantial evidence base in patients in sinus rhythm with significant systolic dysfunction , symptomatic heart failure , and prolonged QRS duration .
The role of CRT is less well established in AF patients with coexistent heart failure .
AV nodal ablation has recently been suggested to improve outcomes in this group .
Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation.
BACKGROUND One third of chronic heart failure patients have major intraventricular conduction and uncoordinated ventricular contraction . Non-controlled studies suggest that biventricular pacing may improve haemodynamics and well-being by reducing ventricular asynchrony . The aim of this trial was to assess the clinical efficacy and safety of this new therapy in patients with chronic atrial fibrillation . METHODS Fifty nine NYHA class III patients with left ventricular systolic dysfunction , chronic atrial fibrillation , slow ventricular rate necessitating permanent ventricular pacing , and a wide QRS complex ( paced width > or=200 ms ) , were implanted with transvenous biventricular-VVIR pacemakers . This single-blind , r and omized , controlled , crossover study compared the patients ' parameters , as monitored during two 3-month treatment periods of conventional right-univentricular vs biventricular pacing . The primary end-point was the 6-min walked distance , secondary end-points were peak oxygen uptake , quality -of-life , hospitalizations , patients ' preferred study period and mortality . RESULTS Because of a higher than expected drop-out rate ( 42 % ) , only 37 patients completed both crossover phases . In the intention-to-treat analysis , we did not observe a significant difference . However , in the patients with effective therapy the mean walked distance increased by 9.3 % with biventricular pacing ( 374+/-108 vs 342+/-103 m in univentricular;P = 0.05 ) . Peak oxygen uptake increased by 13 % ( P=0.04 ) . Hospitalizations decreased by 70 % and 85 % of the patients preferred the biventricular pacing period ( P<0.001 ) . CONCLUSION As compared with conventional VVIR pacing , effective biventricular pacing seems to improve exercise tolerance in NYHA class III heart failure patients with chronic atrial fibrillation and wide paced-QRS complexes . Further r and omized controlled studies are required to definitively vali date this therapy in such patients
AV nodal ablation was associated with a substantial reduction in all-cause mortality and cardiovascular mortality and with improvements in New York Heart Association functional class compared with medical therapy in CRT-AF patients .
OBJECTIVES The aim of this study was to systematic ally review the medical literature to evaluate the impact of AV nodal ablation in patients with heart failure and coexistent atrial fibrillation ( AF ) receiving cardiac resynchronization therapy ( CRT ) .
BACKGROUND CRT has a substantial evidence base in patients in sinus rhythm with significant systolic dysfunction , symptomatic heart failure , and prolonged QRS duration .
The role of CRT is less well established in AF patients with coexistent heart failure .
AV nodal ablation has recently been suggested to improve outcomes in this group .