Cardiac resynchronization therapy after atrioventricular junction ablation for symptomatic atrial fibrillation: a meta-analysis.
OBJECTIVE
Atrioventricular junction (AVJ) ablation with permanent pacing improves symptoms in selected patients with atrial fibrillation (AF). The optimal pacing modality after AVJ ablation remains unclear. We performed a meta-analysis of randomized controlled trials to examine whether cardiac resynchronization therapy (CRT) is superior to right ventricular (RV) pacing in this patient population.


RESULTS
We searched the MEDLINE and EMBASE databases for studies evaluating the effect of CRT vs. RV pacing after AVJ ablation for AF. Pooled risk ratios (RRs) and mean differences with 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively, using a random effects model. Five trials involving 686 patients (413 in CRT and 273 in RV pacing group) were included in the analysis. On the basis of the pooled estimate across the studies, CRT resulted in a non-significant reduction in mortality (RR = 0.75, 95% CI 0.43-1.30; P= 0.30) and a significant reduction in hospitalizations for heart failure (RR = 0.38, 95% CI = 0.17-0.85; P= 0.02) compared with RV pacing. Cardiac resynchronization therapy did not improve 6 min walk distance (mean difference 15.7, 95% CI -7.2 to 38.5 m; P= 0.18) and Minnesota Living with Heart Failure quality-of-life score (mean difference -3.0, 95% CI -8.6 to 2.6; P= 0.30) compared with RV pacing. The change in left ventricular ejection fraction between baseline and 6 months favoured CRT (mean change 2.0%, 95% CI 1.5-2.4%; P< 0.001).


CONCLUSIONS
Cardiac resynchronization therapy may be superior to RV pacing in patients undergoing AVJ ablation for AF. Further studies, adequately powered to detect clinical outcomes, are required.
Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd, WP 3010, Oklahoma City, OK 73104, USA. stavros-stavrakis@ouhsc.edu
Stavros
S
Stavrakis
Paul
P
Garabelli
Dwight W
DW
Reynolds
D001281:Atrial Fibrillation / Q000401:mortality / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D001283:Atrioventricular Node / Q000601:surgery*; D058406:Cardiac Resynchronization Therapy; D017115:Catheter Ablation / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control / Q000523:psychology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D016896:Treatment Outcome