title: Long-term outcomes of cardiac resynchronization therapy are worse in patients who require atrioventricular junction ablation for atrial fibrillation than in those with sinus rhythm.
abstract: BACKGROUND
  The aim of the study was to assess the impact of atrial fibrillation (AF) with and without the need for atrioventricular junction (AVJ) ablation on outcomes in patients undergoing cardiac resynchronization therapy (CRT).
  
  
  METHODS
  A single center cohort of 200 consecutive CRT patients was divided into three groups: 1) AF with CRT pacing < 95% in which AVJ ablation was performed (AF-ABL, n = 40; 20%), 2) AF without the need for AVJ ablation (AF-non ABL, n = 40; 20%), 3) sinus rhythm (SR, n = 120; 60%). All patients were assessed before CRT implantation and at 6-month follow-up. Positive clinical response to CRT was considered alive status without the need for heart transplantation and improvement ≥ 1 NYHA after 6 months. The comparative analysis among all study groups with respect to response-rate and long-term survival was performed.
  
  
  RESULTS
  The 6-month response-rate in both AF-ABL and AF-nonABL was significantly lower than in SR (52.5 and 50 vs.77.5%, respectively; both p < 0.017), though there were no differences in baseline characteristics among study groups apart from higher baseline NT-proBNP levels in AF-ABL. However, after adjustment for this confounder, and despite optimal CRT pacing burden in study groups, the remote all-cause mortality during median follow-up of 36.1 months was significantly higher in AF-ABL than in SR (adjusted HR = 2.57, 95% CI 1.09-6.02, p = 0.03). What is more, no difference in long-term survival between SR and AF-nonABL was observed.
  
  
  CONCLUSIONS
  Despite the improvement of CRT pacing burden and thus response-rate up to the level of AF subjects without the need for ablation, the long-term survival of AF patients requiring AVJ ablation remains still worse than in SR.
authors.affiliation: Department of Cardiology, Congenital Hear t Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland. ewajczyk@op.pl.
authors.forename: Ewa
authors.initials: E
authors.lastname: Jędrzejczyk-Patej
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Michał
authors.initials: M
authors.lastname: Mazurek
authors.forename: Adam
authors.initials: A
authors.lastname: Sokal
authors.forename: Joanna
authors.initials: J
authors.lastname: Boidol
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Woźniak
authors.forename: Sławomir
authors.initials: S
authors.lastname: Pluta
authors.forename: Mariola
authors.initials: M
authors.lastname: Szulik
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Liberska
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome