title: Predictors of clinical efficacy of 'Ablate and Pace' therapy in patients with permanent atrial fibrillation.
abstract: OBJECTIVE
  To evaluate the 2-year clinical improvement after 'Ablate and Pace' therapy and to identify the variables able to influence the efficacy of this therapy in patients with permanent atrial fibrillation (AF). Design Prospective multicentre observational study. Setting Cardiology departments of 19 general hospitals in Italy, Spain and Greece.
  
  
  METHODS
  171 patients with drug-refractory severely symptomatic permanent AF considered for AV junction ablation. Interventions Patients underwent AV junction ablation, received a right ventricular (RV) pacing or echo-guided cardiac resynchronisation (CRT) pacing and were followed-up to 24 months. Main outcome measures Non-responders to Ablate and Pace therapy were defined those patients who, during the follow-up period had clinical failure (defined as death or hospitalisation due to heart failure, or worsening heart failure) or showed no improvement in their clinical condition.
  
  
  RESULTS
  Responders were 63% of RV-paced patients and 83% of CRT-paced patients. Another 27% showed no clinical improvement (7%) or worsened (20%) (non-responders group). On multivariable Cox regression analysis, CRT mode and echo-optimised CRT were the only independent protective factors against non-response (HR=0.24, 95% CI 0.10-0.58, p=0.001 and HR=0.22, 95% CI 0.07-0.77, p=0.018 respectively). On comparing freedom from non-response, a trend in favour of echo-optimised CRT versus simultaneous biventricular pacing (p=0.077) was seen.
  
  
  CONCLUSIONS
  In patients affected by severely symptomatic permanent AF, Ablate and Pace therapy yielded a clinical benefit in 63% of RV-paced patients and 83% of CRT-paced patients. CRT pacing and echo-optimised CRT were the only independent predictor of clinical benefit.
authors.affiliation: Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, 16033 Lavagna, Italy. mbrignole@asl4.liguria.it
authors.forename: M
authors.initials: M
authors.lastname: Brignole
authors.forename: G L
authors.initials: GL
authors.lastname: Botto
authors.forename: L
authors.initials: L
authors.lastname: Mont
authors.forename: D
authors.initials: D
authors.lastname: Oddone
authors.forename: S
authors.initials: S
authors.lastname: Iacopino
authors.forename: G
authors.initials: G
authors.lastname: De Marchi
authors.forename: M
authors.initials: M
authors.lastname: Campoli
authors.forename: V
authors.initials: V
authors.lastname: Sebastiani
authors.forename: A
authors.initials: A
authors.lastname: Vincenti
authors.forename: D
authors.initials: D
authors.lastname: Garcia Medina
authors.forename: J
authors.initials: J
authors.lastname: Osca Asensi
authors.forename: A
authors.initials: A
authors.lastname: Mocini
authors.forename: N
authors.initials: N
authors.lastname: Grovale
authors.forename: T
authors.initials: T
authors.lastname: De Santo
authors.forename: C
authors.initials: C
authors.lastname: Menozzi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome