Clin Res Cardiol 96:Suppl 2 (2007)

P333 - Atrioventricular node ablation is not a prerequisite for cardiac resynchronisation therapy in patients with chronic atrial fibrillation
 
F. Schütte1, G. Lüdorff2, R. Grove3, W. Kranig3, J. Thale1
 
1Klinikum Osnabrück, Med. Klinik I, Herzzentrum Osnabrück - Bad Rothenfelde, Osnabrück; 2Kardiologie Schüchtermann-Klinik, Herzzentrum Osnabrück-Bad Rothenfelde, Bad Rothenfelde; 3Schüchtermann Klinik, Herzzentrum Osnabrück-Bad Rothenfelde, Bad Rothenfelde;
 
Introduction: Cardiac resynchronisation therapy (CRT) is an established method for drug refractory heart failure in patients with severe reduced ejection fraction and broad QRS. There is growing evidence that the benefit in patients with chronic atrial fibrillation (AF) and heart failure is similar to that in patients with sinus rhythm. However, the putative improvement of atrioventricular node (AVN) ablation in AF and biventricular stimulation remains unclear.
The aim of the present study was to elucidate the effects of CRT in patients with chronic AF and the requirement of AVN ablation.
Methodes: A total of 31 patients with chronic AF (19 % of 161 patients in the window of interest) with mean duration of 2.9 ± 2.9 years were included in the retrospective study (follow-up 11 ± 8 months). Clinical parameters (NYHA class), QRS duration and echocardiographic parameters were compared in 27 Patients (87 %, group 1) who received an optimized medication to control ventricular rate, thus resulting in adequate delivery of biventricular pacing (biventricular stimulation > 90 %) and 4 patients (13 %, group 2) who underwent an AVN ablation.
Results: Baseline characteristics between patients with AF in the presence or absence of AVN ablation were comparable. Furthermore, the significant improvement of NYHA-class (group 1: 3.2 ± 0.1 vs. 2.2 ± 0.1, p < 0.01; group 2: 3.1 ± 0.1 vs. 1.9 ± 0.1, p < 0.01), QRS duration (group 1: 189.5 ± 5.2 ms vs. 156.6 ± 3.5 ms, p < 0.01; group 2: 187.5 ± 4.8 ms vs. 145.0 ± 2.0 ms, p < 0.05), ejection fraction (group 1: 23.7 ± 1.2 % vs. 40.0 ± 1.8 %, p < 0.01; group 2: 25.0 ± 3.5 % vs. 41.3 ± 1.3 %, p < 0.05) and left ventricular end-diastolic dimension (LVEDD) (group 1: 69.6 ± 1.6 mm vs. 62.9 ± 1.4 mm, p < 0.05; group 2: 67.0 ± 1.8 mm vs. 55.0 ± 2.8 mm, p < 0.01) were in both groups similar.
Conclusion: The present results show a comparable improvement in left ventricular function and functional capacity in both treated groups. In conclusion, AVN ablation is not a prerequisite for cardiac resynchronisation in patients with severe heart failure and chronic atrial fibrillation. Sufficient rate control (or well known conversion in sinus rhythm with CRT) is the successful therapy option for the majority of patients with chronic AF and indication for CRT. AVN-ablation is indicated if rate control belongs insufficient.
 

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