CLINICAL RESEARCH
Four-Year Efficacy of Cardiac Resynchronization Therapy on Exercise Tolerance and Disease Progression
The Importance of Performing Atrioventricular Junction Ablation in Patients With Atrial Fibrillation
Maurizio Gasparini, MD*,*,
Angelo Auricchio, MD, PhD , ,
François Regoli, MD*,
Cecilia Fantoni, MD,
Mihoko Kawabata, MD,
Paola Galimberti, MD*,
Daniela Pini, MD*,
Carlo Ceriotti, MD*,
Edoardo Gronda, MD*,
Catherine Klersy, MD, MSc ,
Simona Fratini, MD and
Helmut H. Klein, MD
* Department of Cardiology IRCCS Istituto Clinico Humanitas Rozzano-Milano, Milan, Italy
Service of Biometry & Clinical Epidemiology, IRCCS Policlinico San Matteo, Pavia, Italy
Division of Cardiology, University Hospital, Magdeburg, Germany
Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
Manuscript received November 11, 2005;
revised manuscript received February 10, 2006,
accepted March 16, 2006.
* Reprint requests and correspondence: Dr. Maurizio Gasparini, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italy, Via Manzoni 56, Rozzano, Milano, Italy. (Email: maurizio.gasparini{at}humanitas.it).
OBJECTIVES: The goal of this study was to investigate the effects of cardiac resynchronization therapy (CRT) in heart failure patients with permanent atrial fibrillation (AF) and the role of atrioventricular junction (AVJ) ablation.
BACKGROUND: Cardiac resynchronization therapy has been proven effective in heart failure patients with sinus rhythm (SR). However, little is known about the effects of CRT in heart failure patients with permanent AF.
METHODS: Efficacy of CRT on ventricular function, exercise performance, and reversal of maladaptive remodeling process was prospectively compared in 48 patients with permanent AF in whom ventricular rate was controlled by drugs, thus resulting in apparently adequate delivery of biventricular pacing (>85% of pacing time), and in 114 permanent AF patients, who had undergone AVJ ablation (100% of resynchronization therapy delivery). The clinical and echocardiographic long-term outcomes of both groups were compared with those of 511 SR patients treated with CRT.
RESULTS: Both SR and AF groups showed significant and sustained improvements of all assessed parameters (model p < 0.001 for all parameters). However, within the AF group, only patients who underwent ablation showed a significant increase of ejection fraction (p < 0.001), reverse remodeling effect (p < 0.001), and improved exercise tolerance (p < 0.001); no improvements were observed in AF patients who did not undergo ablation.
CONCLUSIONS: Heart failure patients with ventricular conduction disturbance and permanent AF treated with CRT showed large and sustained long-term (up to 4 year) improvements of left ventricular function and functional capacity, similar to patients in SR, only if AVJ ablation was performed.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | AVJ = atrioventricular junction | | CRT = cardiac resynchronization therapy | | LVEDD = left ventricular end-diastolic diameter | | LVEF = left ventricular ejection fraction | | LVESV = left ventricular end-systolic volume | | NYHA = New York Heart Association | | SR = sinus rhythm | | VRR = ventricular rate regularization |
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