title: Impact of chronic atrial fibrillation in patients with severe heart failure and indication for CRT: data of two registries with 711 patients (1999-2006 and 2007-6/2008).
abstract: OBJECTIVE
  Atrial fibrillation (AF) is a relevant comorbidity in heart failure (HF) patients. In milestone cardiac resynchronization therapy (CRT) studies, patients with AF were excluded. We sought to investigate the influence of chronic atrial fibrillation (AF) on patients with CRT. AV node (AVN) ablation is frequently recommended. Converting AF to sinus rhythm (SR) is not a standard concept.
  
  
  METHODS
  A total of 584 consecutive patients with CRT devices were included in a single-center registry from 1999-2006 (retrospective registry) and 127/324 patients from 2007-06/2008 (prospective registry). The impact of persistent AF (group 1) on clinical and echocardiographic improvement compared with patients in SR (group 2) after 12 (6) months follow-up were analyzed. Re-establishing SR after initial cardioversion or need for AVN ablation was examined.
  
  
  RESULTS
  In the retrospective registry, 139 (24%) patients presented with AF (group 1) and 445 with SR (group 2). The groups differed in age, gender, and left atrium (LA) size but not in NYHA class, ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD), B-type natriuretic peptide (BNP) levels, QRS width, and underlying disease. After 1 year, CRT improvement of NYHA class and EF was similar with higher mortality in group 1 (12% vs. 7%; OR 1.80; 95% confidence interval 0.95-3.4). The AF group presented with SR in 33/82 (40%) patients and 11% needed AVN ablation. The prospective data showed 27 (21%) patients in AF with conversion to SR in 41% after 6 months.
  
  
  CONCLUSIONS
  Patients with severe HF and chronic AF had a comparable improvement with CRT as those in SR. CRT is a successful treatment option in patients with chronic AF offering the potential to restore SR in a significant number of patients.
authors.affiliation: Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, 49214, Bad Rothenfelde, Germany. g.luedorff@schuechtermann-klink.de
authors.forename: G
authors.initials: G
authors.lastname: Luedorff
authors.forename: R
authors.initials: R
authors.lastname: Grove
authors.forename: M
authors.initials: M
authors.lastname: Kowalski
authors.forename: E
authors.initials: E
authors.lastname: Wolff
authors.forename: J
authors.initials: J
authors.lastname: Thale
authors.forename: W
authors.initials: W
authors.lastname: Kranig
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate