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A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS

2018; Oxford University Press; Volume: 39; Issue: 45 Linguagem: Inglês

10.1093/eurheartj/ehy555

1522-9645

Michele Brignole, Evgeny Pokushalov, F. Pentimalli, Pietro Palmisano, Enrico Chieffo, Eraldo Occhetta, Fabio Quartieri, Leonardo Caló, Andrea Ungar, Lluı́s Mont, C. Menozzi, Paoló Alboni, Giovanni Bertero, Catherine Klersy, Franco Noventa, Michele Brignole, Daniele Oddone, O Donateo, Roberto Maggi, Francesco Croci, A. Solano, F. Pentimalli, Pietro Palmisano, Maurizio Landolina, Enrico Chieffo, Erika Taravelli, Eraldo Occhetta, Fabio Quartieri, Nicola Bottoni, Matteo Iori, Leonardo Caló, Marianna Sgueglia, Pieragnoli, Andrea Giorni, Martina Nesti, I. Giannini, Andrea Ungar, Luigi Padeletti, Evgeny Pokushalov, Alexander Romanov, Ю. С. Перегудов, S Vidorreda, Raquel Núñez, Lluı́s Mont, G. Corbucci, Sergio Valsecchi, Mariolina Lovecchio,

Atrial Fibrillation Management and Outcomes

We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS. We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18–0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11–0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11–0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004). Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS. NCT02137187 (May 2018, date last accessed).