Objective To compare the effects of cardiac resynchronisation therapy (CRT) in patients with heart failure in either atrial fibrillation (AF) or sinus rhythm (SR).
Design Prospective observational study
Patients 295 consecutive patients with heart failure (permanent AF in 66, paroxysmal AF in 20, SR in 209; NYHA class III or IV; LVEFiÜ35%, QRSiÝ120 ms].
Interventions All patients underwent CRT without atrioventricular junction ablation.
Main outcome measures The primary endpoint was the composite endpoints of cardiovascular death or unplanned hospitalization for major cardiovascular events. Secondary endpoints included the composite endpoint of cardiovascular death or hospitalization for worsening heart failure. Cardiovascular mortality, total mortality and changes in NYHA class, 6-min walking distance, quality of life (Minnesota Living with Heart Failure questionnaire ) and echocardiographic variables were also considered.
Results Over a follow-up period of up to 6.8 years, no differences emerged between patients in AF or SR in any of the mortality or morbidity endpoints. The AF and SR groups derived similar improvements in NYHA class [-1.3 vs -1.2, (mean)], 6-min walking distance (92.3 vs 78.4 m) and quality of life scores (-25.2 vs -18.7) (all p<0.0001). Reductions in left ventricular end-systolic (-25.9 vs -34.5 mL, both p<0.0001) and end-diastolic [(-20.2 mL (p=0.001) vs 26.2 mL (p=0.0007)] volumes and improvements in LVEF (4.69 vs 7.86%, both p<0.0001) were observed in both the AF and SR groups.
Conclusions Cardiac resynchronisation therapy leads to similar prognostic and symptomatic benefits in patients in AF and SR, even without atrioventricular junction ablation. Echocardiographic improvements are also comparable.
- atrial fibrillation
- cardiac resynchronisation therapy
- heart failure
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