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 ) .
Frequency and Outcomes of Postrandomization Atrial Tachyarrhythmias in the Resynchronization/Defibrillation in Ambulatory Heart Failure Trial
Background —Whether adding cardiac resynchronization therapy ( CRT-D ) to an implanted cardioverter – defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias ( AF/AT ) , or if postimplantation AF/AT modulate the benefits of CRT-D , remain unknown . Methods and Results —We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial ( RAFT ) participants without permanent AF , who were r and omized to CRT-D ( n=495 ) versus nonresynchronization defibrillator ( implanted cardioverter – defibrillator ; n=477 ) within the predefined stratum eligible for an atrial lead . Occurrence of postr and omization AF/AT was prospect ively assessed , and Cox models were used to test the independent association between the postr and omization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure . Over 41 ( ±19 ) months , postr and omization AF/AT occurred in 216 ( 45.3 % ) patients r and omized to implanted cardioverter – defibrillator and 249 ( 50.3 % ) r and omized to CRT-D. After adjusting for competing risk of death , r and omization to CRT-D increased risk of postr and omization AF/AT ( hazard ratio , 1.20 ; 95 % confidence interval , 1.00–1.42 ; P=0.045 ) . Postr and omization AF/AT , which remained paroxysmal in 69.5 % , did not reduce biventricular pacing percentage . In adjusted models , postr and omization AF/AT was not associated with the primary outcome ( hazard ratio , 1.04 ; 95 % confidence interval , 0.84–1.30 ) . However , AF/AT was associated with a borderline decreased risk of mortality ( hazard ratio , 0.75 ; 95 % confidence interval , 0.58–1.00 ) but increased risk of heart failure hospitalization ( hazard ratio , 1.43 ; 95 % confidence interval , 1.08–1.90 ) . Conclusions —In RAFT , nearly half of the patients developed postr and omization AF/AT , and those r and omized to CRT-D had borderline significant higher risk . Postr and omization AF/AT was associated with risk of heart failure hospitalization , but not with the primary composite outcome . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : 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 ) .