Cardiac Resynchronization Therapy in Patients with Atrial Fibrillation: A 2-Year Follow-Up Study

Authors

  • ALON EISEN M.D.,

    Corresponding author
    • Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • ROMAN NEVZOROV M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • GUSTAVO GOLDENBERG M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • HAIM KUZNITZ M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • AVITAL PORTER M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • GREGORY GOLOVTZINER M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • BORIS STRASBERG M.D.,

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author
  • MOTI HAIM M.D.

    1. Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    Search for more papers by this author

Address for reprints: Alon Eisen, M.D., Department of Cardiology, Rabin Medical Center-Beilinson Campus, Petah Tikva 49100, Israel. Fax: 03–9213221; e-mail: a_alon1@netvision.net.il

Abstract

Introduction

Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF) and represents an important comorbidity in these patients. Cardiac resynchronization therapy (CRT) has been shown to be beneficial in patients with HF. Whether patients with AF benefit similarly from CRT as their counterparts in sinus rhythm is controversial.

Methods and Results

We conducted a cohort analysis of 175 patients (138 men; age range 57–79 years) who underwent CRT implantation during 2004–2008 in our institution. AF was documented in 66 patients (37.7% of patients, 52 men). There were no differences in 1- or 2-year mortality between patients with and without AF (13.6% vs 11.79%, P = 0.7; 25.8% vs 16.9%, P = 0.2, respectively). There were no differences between the groups in the rate of complications after CRT implantation or in the rate of appropriate electrical shocks. In the subgroup of AF patients with cardiac resynchronization therapy defibrillator (CRT-D) (n = 32, 48.5%), the 1-year mortality was 3.1% as compared to 23.5% in AF patients with cardiac resynchronization therapy pacemaker (P = 0.03). This difference was no longer evident after 2 years (25.0% vs 26.5%, P = 0.8, respectively). Ten patients (15.2%) with AF underwent atrioventricular (AV) node ablation. The 2-year mortality of these patients was 10.0% as compared to 28.6% in AF patients who did not undergo AV-node ablation (P = 0.4).

Conclusions

In this study, no difference in mortality appears to exist between patients with or without AF and who undergo CRT implantation. Our findings of the beneficial effects of AV-node ablation and CRT-D in AF patients deserve further investigation.

Ancillary