title: Comparison of the rhythm control treatment strategy versus the rate control strategy in patients with permanent or long-standing persistent atrial fibrillation and heart failure treated with cardiac resynchronization therapy - a pilot study of Cardiac Resynchronization in Atrial Fibrillation Trial (Pilot-CRAfT): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The only subgroups of patients with heart failure and atrial fibrillation in which the efficacy of cardiac resynchronization therapy has been scientifically proven are patients with indications for right ventricular pacing and patients after atrioventricular junction ablation. However it is unlikely that atrioventricular junction ablation would be a standard procedure in the majority of the heart failure patients with cardiac resynchronization therapy and concomitant atrial fibrillation due to the irreversible character of the procedure and a spontaneous sinus rhythm resumption that occurs in about 10% of these patients.
  
  
  METHODS
  Pilot-CRAfT is the first randomized controlled trial evaluating the efficacy of a rhythm control strategy in atrial fibrillation patients with cardiac resynchronization therapy devices. The aim of this prospective, single center randomized controlled pilot study is to answer the question whether the patients with cardiac resynchronization therapy and permanent atrial fibrillation would benefit from a strategy to restore and maintain sinus rhythm (that is 'rhythm control' strategy) in comparison to rate control strategy. The study population consists of 60 patients with heart failure and concomitant long-standing persistent or permanent atrial fibrillation who underwent a cardiac resynchronization therapy device implantation at least 3 months before qualification. Study participants are randomly assigned to the rhythm control strategy (including electrical cardioversion and pharmacotherapy) or to the rate control group whose goal is to control ventricular rate. The follow-up time is 12 months. The primary endpoint is the ratio of effectively captured biventricular beats. The secondary endpoints include peak oxygen consumption, six-minute walk test distance, heart failure symptom escalation, reverse remodelling of the heart on echo and quality of life.
  
  
  BACKGROUND
  NCT01850277 registered on 22 April 2013 (ClinicalTrials.gov).
authors.affiliation: From the Second Department of Coronary Artery Disease, Institute of Cardiology, Warszawa, Poland. jciszewski@ikard.pl.
authors.forename: Jan
authors.initials: J
authors.lastname: Ciszewski
authors.forename: Aleksander
authors.initials: A
authors.lastname: Maciag
authors.forename: Ilona
authors.initials: I
authors.lastname: Kowalik
authors.forename: Pawel
authors.initials: P
authors.lastname: Syska
authors.forename: Michal
authors.initials: M
authors.lastname: Lewandowski
authors.forename: Michal M
authors.initials: MM
authors.lastname: Farkowski
authors.forename: Anna
authors.initials: A
authors.lastname: Borowiec
authors.forename: Tomasz
authors.initials: T
authors.lastname: Chwyczko
authors.forename: Mariusz
authors.initials: M
authors.lastname: Pytkowski
authors.forename: Hanna
authors.initials: H
authors.lastname: Szwed
authors.forename: Maciej
authors.initials: M
authors.lastname: Sterlinski
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D047548:Defibrillators; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010865:Pilot Projects; D011044:Poland; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents