title: Cardiac resynchronization therapy in patients with atrial fibrillation: a 2-year follow-up study.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF) and represents an important comorbidity in these patients. Cardiac resynchronization therapy (CRT) has been shown to be beneficial in patients with HF. Whether patients with AF benefit similarly from CRT as their counterparts in sinus rhythm is controversial.
  
  
  RESULTS
  We conducted a cohort analysis of 175 patients (138 men; age range 57-79 years) who underwent CRT implantation during 2004-2008 in our institution. AF was documented in 66 patients (37.7% of patients, 52 men). There were no differences in 1- or 2-year mortality between patients with and without AF (13.6% vs 11.79%, P = 0.7; 25.8% vs 16.9%, P = 0.2, respectively). There were no differences between the groups in the rate of complications after CRT implantation or in the rate of appropriate electrical shocks. In the subgroup of AF patients with cardiac resynchronization therapy defibrillator (CRT-D) (n = 32, 48.5%), the 1-year mortality was 3.1% as compared to 23.5% in AF patients with cardiac resynchronization therapy pacemaker (P = 0.03). This difference was no longer evident after 2 years (25.0% vs 26.5%, P = 0.8, respectively). Ten patients (15.2%) with AF underwent atrioventricular (AV) node ablation. The 2-year mortality of these patients was 10.0% as compared to 28.6% in AF patients who did not undergo AV-node ablation (P = 0.4).
  
  
  CONCLUSIONS
  In this study, no difference in mortality appears to exist between patients with or without AF and who undergo CRT implantation. Our findings of the beneficial effects of AV-node ablation and CRT-D in AF patients deserve further investigation.
authors.affiliation: Cardiac Electrophysiology and Pacing Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. a_alon1@netvision.net.il
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.forename: Roman
authors.initials: R
authors.lastname: Nevzorov
authors.forename: Gustavo
authors.initials: G
authors.lastname: Goldenberg
authors.forename: Haim
authors.initials: H
authors.lastname: Kuznitz
authors.forename: Avital
authors.initials: A
authors.lastname: Porter
authors.forename: Gregory
authors.initials: G
authors.lastname: Golovtziner
authors.forename: Boris
authors.initials: B
authors.lastname: Strasberg
authors.forename: Moti
authors.initials: M
authors.lastname: Haim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: AV-node ablation; atrial fibrillation; cardiac resynchronization therapy; heart failure