title: Cardiac resynchronization therapy in patients with atrial fibrillation: the CERTIFY study (Cardiac Resynchronization Therapy in Atrial Fibrillation Patients Multinational Registry).
abstract: OBJECTIVE
  The purpose of this study is to determine whether, in patients with atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT), atrioventricular junction ablation (AVJA) is associated with a better outcome than treatment with rate-slowing drugs.
  
  
  BACKGROUND
  Different trials have demonstrated that CRT is effective in treating heart failure (HF) patients who are in sinus rhythm (SR). No trials have addressed whether CRT confers similar benefits on AF patients, with or without AVJA.
  
  
  METHODS
  The clinical outcomes of CRT for patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) were compared with those of SR patients (n = 6,046).
  
  
  RESULTS
  Median follow-up was 37 months. Total mortality (6.8 vs. 6.1 per 100 person-years) and cardiac mortality (4.2 vs. 4.0) were similar for patients with AF+AVJA and patients in SR (both p = NS). In contrast, the AF+drugs group had a higher total and cardiac mortality than the SR group and the AF+AVJA group (11.3 and 8.1, respectively; p < 0.001). On multivariable analysis, AF+AVJA had total mortality (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74 to 1.67) and cardiac mortality (HR: 0.88, 95% CI: 0.66 to 1.17) similar to that of the SR group, independent of known confounders. The AF+drugs group, however, had a higher total mortality (HR: 1.52, 95% CI: 1.26 to 1.82) and cardiac mortality (HR: 1.57, 95% CI: 1.27 to 1.94) than both the SR group and the AF+AVJA group (both p < 0.001).
  
  
  CONCLUSIONS
  Long-term survival after CRT among patients with AF+AVJA is similar to that observed among patients in SR. Mortality is higher for AF patients treated with rate-slowing drugs.
authors.affiliation: Electrophysiology and Pacing Unit, Humanitas Research Hospital, Rozzano, Italy. Electronic address: maurizio.gasparini@humanitas.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.affiliation: Department of Cardiology, University Hospital Rennes, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: Cardiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lunati
authors.affiliation: Cardiology Department, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.affiliation: Fondazione Cardiocentro Ticino, Lugano, Switzerland.
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
authors.affiliation: Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.affiliation: Institute of Cardiology, University of Bologna and Azienda Ospedaliera Sant' Orsola-Malpighi, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre NRV, Bad Oeynhausen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lamp
authors.affiliation: Department of Cardiology, Santa Maria della Misericordia Hospital, Udine, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.affiliation: Cardiology Department, Spedali Civili, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Curnis
authors.affiliation: Biometry and Clinical Epidemiology, Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation of atrioventricular junction; atrial fibrillation; cardiac resynchronization therapy; heart failure