Comparison of response to cardiac resynchronization therapy in patients with sinus rhythm versus chronic atrial fibrillation
Section snippets
Patients and study design
Based on traditional selection criteria of patients who have drug-refractory heart failure (New York Heart Association [NYHA] class III or IV, left ventricular ejection fraction <35%, QRS duration >120 ms or >200 ms for a paced QRS, and left bundle branch block configuration), 30 consecutive patients who had sinus rhythm and 30 consecutive patients who had AF underwent implantation of a CRT device. All patients who had AF had a persistent type (>3 months). All subjects are part of a prospective
Baseline characteristics
Thirty consecutive patients who had sinus rhythm and 30 consecutive patients who had AF underwent CRT and were included in the study. The study population comprised 51 men and 9 women (mean age 65 ± 9 years). Underlying etiology was nonischemic in 31 patients (52%) and ischemic in 29 patients (48%). Mean NYHA class was 3.2 ± 0.4, with most patients (80%) in NYHA class III. Medication included diuretics in all patients, angiotensin-converting enzyme inhibitors in 90%, β blockers in 50%,
Discussion
In the present study, the benefit of CRT in patients who had AF was compared with that in patients who had sinus rhythm. The main findings are that (1) benefit, as measured by clinical parameters (NYHA class, exercise capacity, and quality of life score), was comparable between patients who had sinus rhythm and those who had AF; (2) the number of nonresponders was higher among patients who had AF; (3) the decrease in hospitalization rate was comparable between patients who had AF and those who
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2019, Cardiac Electrophysiology ClinicsImpact on long-term cardiovascular outcomes of different cardiac resynchronization therapy response criteria
2018, Revista Portuguesa de CardiologiaUtility of Frailty Assessment for Elderly Patients Undergoing Cardiac Resynchronization Therapy
2017, JACC: Clinical ElectrophysiologyContinuous optimization of cardiac resynchronization therapy reduces atrial fibrillation in heart failure patients: Results of the Adaptive Cardiac Resynchronization Therapy Trial
2017, Heart RhythmCitation Excerpt :However, the effect of CRT on AF is less clear. Many observational studies have suggested that CRT reduces the risk of AF.11–16 Yet, data from 3 large clinical trials have shown conflicting results; 1 study found no benefit,17 another found benefit only in patients with significant left atrial (LA) remodeling,18 and a third found a trend toward an increased incidence of AF.19
Dr. Molhoek received grant 2001D015, and Dr. Bleeker received grant 2002B109 from the Dutch Heart Foundation, The Hague, and the Interuniversity Cardiology Institute of Netherlands, Utrecht, The Netherlands.