title: Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF): protocol for a randomized clinical trial.
abstract: BACKGROUND
  Heart failure(HF) and atrial fibrillation(AF) frequently coexist in the same patient and are associated with increased mortality and frequent hospitalizations. As the concomitance of AF and HF is often associated with a poor prognosis, the prompt treatment of AF in HF patients may significantly improve outcome.
  
  
  METHODS
  Recent implantable cardiac resynchronization (CRT) devices allow electrical therapies to treat AF automatically. TRADE-HF (trial registration: NCT00345592; http://www.clinicaltrials.gov) is a prospective, randomized, double arm study aimed at demonstrating the efficacy of an automatic, device-based therapy for treatment of atrial tachycardia and fibrillation(AT/AF) in patients indicated for CRT. The study compares automatic electrical therapy to a traditional more usual treatment of AT/AF: the goal is to demonstrate a reduction in a combined endpoint of unplanned hospitalizations for cardiac reasons, death from cardiovascular causes or permanent AF when using automatic atrial therapy as compared to the traditional approach involving hospitalization for symptoms and in-hospital treatment of AT/AF.
  
  
  CONCLUSIONS
  CRT pacemaker with the additional ability to convert AF as well as ventricular arrhythmias may play a simultaneous role in rhythm control and HF treatment. The value of the systematic implantation of CRT ICDs with the capacity to deliver atrial therapy in HF patients at risk of AF has not yet been explored. The TRADE-HF study will assess in CRT patients whether a strategy based on automatic management of atrial arrhythmias might be a valuable option to reduce the number of hospital admission and to reduce the progression the arrhythmia to a permanent form.
  
  
  BACKGROUND
  NCT00345592.
authors.affiliation: U.O. di Cardiologia, Ospedale S, Anna, Como, Italy. gianlucabotto@interfree.it
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Stefano
authors.initials: S
authors.lastname: Favale
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grandinetti
authors.forename: Paolo
authors.initials: P
authors.lastname: De Filippo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raciti
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D004867:Equipment Design; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007558:Italy; D011446:Prospective Studies; D012107:Research Design; D016896:Treatment Outcome