title: Cardiac resynchronization therapy in patients with permanent atrial fibrillation. Is it mandatory to ablate the atrioventricular junction to obtain a good response?
abstract: OBJECTIVE
  Current guidelines recommend atrioventricular junction (AVJ) ablation in patients with atrial fibrillation (AF) treated with cardiac resynchronization therapy (CRT). Our study compared the CRT response of patients in sinus rhythm (SR) vs. AF.
  
  
  RESULTS
  In this observational, prospective, multicentre study, patients were grouped by intrinsic rhythm. For the first 2 months, the negative chronotropic drug was optimized in the AF group. If ventricular pacing was ≤85%, AVJ ablation was recommended. Responders were defined as patients who survived without requiring heart transplant and had a ≥ 10% reduction in left ventricular end-systolic volume (LVESV) at 12 months after implantation. Of 202 patients included, 156 (77%) were in SR and 46 (23%) had AF. After drug optimization, only 13/46 (28%) of the AF patients required AVJ ablation (AF + AVJ). The percentage of responders was 83/156 (53%) for SR vs. 22/46 (48%) AF (P = 0.4). Among AF patients the response was 16/33 (48%) for AF with non-AVJ ablation vs. 6/13 (46%) AF + AVJ, P = 0.56. The LVESV decreased in all three groups: -30 ± 39 mL, -24 ± 43 mL, and -22 ± 36 mL, respectively (P = 0.75). Mortality was higher in patients with AF compared with SR: 10/46 (21%) vs. 9/156 (5.7%), log rank 10.6, P <0.05.
  
  
  CONCLUSIONS
  Although only 28% of the patients in AF had the AVJ ablated, there were no differences in the percentage of response and echo improvement between patients in SR and AF. However, mortality was higher in patients with AF compared with patients in SR.
authors.affiliation: Cardiology Department-Thorax Institute. Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Catalonia, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Ana Martín
authors.initials: AM
authors.lastname: Arnau
authors.forename: Antonio Hernández
authors.initials: AH
authors.lastname: Madrid
authors.forename: Alfonso
authors.initials: A
authors.lastname: Macias
authors.forename: Ignacio Fernández
authors.initials: IF
authors.lastname: Lozano
authors.forename: Joaquín
authors.initials: J
authors.lastname: Osca
authors.forename: Aurelio
authors.initials: A
authors.lastname: Quesada
authors.forename: Jorge
authors.initials: J
authors.lastname: Toquero
authors.forename: Roberto Matia
authors.initials: RM
authors.lastname: Francés
authors.forename: Ignacio García
authors.initials: IG
authors.lastname: Bolao
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Mónica Gimenez
authors.initials: MG
authors.lastname: Alcalá
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001283:Atrioventricular Node / Q000473:pathology*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D013030:Spain; D013223:Statistics as Topic; D014463:Ultrasonography