title: [Causes of non-response to cardiac resynchronization therapy in heart failure patients with permanent atrial fibrillation].
abstract: OBJECTIVE
  To evaluate the long-term effects and analyze causes of non-response to cardiac resynchronization therapy (CRT) in heart failure (HF) patients with permanent atrial fibrillation (AF).
  
  
  METHODS
  Thirty-three patients with HF and AF [29 men, mean age (61 ± 10) years, NYHA class III or IV, left ventricular ejection fraction (LVEF) ≤ 35%, QRS ≥ 120 ms in 31 cases] underwent bi-ventricular pacing (n = 26) or bi-ventricular pacing and atrioventricular node ablation (AVN-ablation, n = 7) were included in this study. Non-response was defined: the increase of left ventricular ejection fraction (LVEF) was less than 15%. Patients were followed-up for 4 years.
  
  
  RESULTS
  Six patients died during follow up. Non-responder to CRT was observed in 6 out of 27 survived patients (22.22%). Six out of 7 patients underwent AVN-ablation were in responder group and 1 in non-responder group. Comparing with responder group, the baseline LVEF was significantly higher (37% vs. 32%, P = 0.003), and the history of HF was significantly longer (6.3 years vs. 4.1 years, P = 0.039), pulmonary artery pressure was significantly higher (53 vs. 32 mm Hg, P = 0.027), bi-ventricular pacing percentage (BIVP%) was significantly lower (75.86% vs. 91.73%, P = 0.007) in non-responder group.
  
  
  CONCLUSIONS
  Higher LVEF, longer HF history, higher pulmonary artery pressure and lower BIVP% are factors linked with non-responses to CRT in this patient cohort. CRT plus AVN-ablation is associated with high response rate to CRT in this patient cohort.
authors.affiliation: Department of Cardiology, Bethune International Peace Hospital, Shijiazhuang, China. slwangdm@126.com
authors.forename: Dong-mei
authors.initials: DM
authors.lastname: Wang
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Yu
authors.forename: Shu-ying
authors.initials: SY
authors.lastname: Qi
authors.forename: Chao
authors.initials: C
authors.lastname: Ding
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Ya-ling
authors.initials: YL
authors.lastname: Han
authors.forename: Hong-yun
authors.initials: HY
authors.lastname: Zang
authors.forename: Lei-sheng
authors.initials: LS
authors.lastname: Ru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome