Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study).
The efficacy of cardiac resynchronization therapy (CRT) in patients with atrial fibrillation (AF) and the need for atrioventricular junction ablation in these patients is controversial. The aim of the study was to analyze CRT results in patients with permanent AF. A total of 470 consecutive patients who underwent CRT in 6 centers were included in this study. Of these patients, 126 (27%) had permanent AF. Patients were evaluated at baseline and 12 months. No difference was found in the magnitude of improvement experienced by patients with AF compared with those in sinus rhythm (SR) with respect to quality of life, distance in 6-minute walking test, and left ventricular reverse remodeling. Despite the beneficial effects of CRT, death from refractory heart failure at 12 months was higher in patients with AF (17 of 126; 13.5%) than those in SR (14/344; 4.1%; p <0,001). Furthermore, permanent AF was an independent predictive factor for mortality from refractory heart failure (hazard ratio 5.4, 95% confidence interval 1.9 to 15.1). In conclusion, patients with AF treated with CRT who survived at the 12-month follow-up had the same functional improvement and remodeling as those in SR. However, AF was an independent risk factor for mortality from heart failure after CRT implantation.
Tolosana
Jose Maria
JM
Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain.
Hernandez Madrid
Antonio
A
Brugada
Josep
J
Sitges
Marta
M
Garcia Bolao
Ignacio
I
Fernandez Lozano
Ignacio
I
Martinez Ferrer
Jose
J
Quesada
Aurelio
A
Macias
Alfonso
A
Marin
Walter
W
Escudier
Juan Manuel
JM
Gomez
Antonio Alonso
AA
Gimenez Alcala
Mónica
M
Tamborero
David
D
Berruezo
Antonio
A
Mont
Lluís
L
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D016001:Confidence Intervals; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume; D013997:Time Factors