Atrial fibrillation in cardiac resynchronization therapy

Elliott, Mark K.; Mehta, Vishal; Martic, Dejana; Sidhu, Baldeep S.; Niederer, Steven; Rinaldi, Christopher A.

doi:10.1016/j.hroo.2021.09.003

Cited by 12 publications

(7 citation statements)

References 70 publications

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“…To avoid CRT therapeutic failure, it is worth looking for predictors which would identify patients more prone to AF. Such patients might be subjected to some additional therapeutic measures, such as ablation, to increase success rate in CRT [14,53,54]. In our study, we have managed to identify three significant predictors of AF in patients with HF undergoing CRT.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy

Grbović,

Pavlović,

Žugić

2023

Medicina

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Background and Objectives: Cardiac resynchronization therapy (CRT) is one of the effective therapeutic options in the treatment of systolic heart failure (HF) with persistent symptoms. This prospective study was designed to determine whether CRT with biventricular pacing would reduce the risk of development of atrial fibrillation (AF) and to identify predictors for AF occurrence. Materials and Methods: The study population consisted of 126 patients, with a mean age of 63.8 ± 9.1 years, who were eligible for CRT with biventricular pacing. Inclusion criteria were left ventricular ejection fraction (LVEF) ≤ 35%, QRS duration ≥ 130 msec, and persistent HF symptoms of New York Heart Association (NYHA) II or III, despite optimal drug therapy. Patients were followed for a period of 24 months and were evaluated through clinical, electrocardiographic, and echocardiographic examination at baseline (prior to CRT implantation), as well as at 6 and 24 months post-implantation. At the end of follow-up, patients were divided into clinical responders and non-responders based on the following criteria: decrease in NYHA class ≥ I, increase in LVEF ≥ 10%, and reduction in QRS duration ≥ 20 msec. Results: At follow-up, CRT was associated with a significant increase in LVEF (20.6 ± 6.9% pre-implantation, 32.9 ± 9.3% 24 months after implantation; p < 0.001), reduction in left ventricular end-diastolic and end-systolic diameters, and decrease in QRS duration (167.6 ± 14.3 msec pre-implantation, 131.7 ± 11.7 msec 24 months after implantation; p < 0.001), while left atrial (LA) diameter was slightly increased (p = 0.070). The frequency of AF occurrence increased after two years of follow-up (52.4% to 56.9%, p < 0.001). Significant predictors of AF occurrence in our study population were response to CRT—AF more frequent in non-responders (B = 8.134; p < 0.001), LA diameter—AF more frequent with larger LA diameter (B = 0.813; p < 0.001), and coronary sinus (CS) lead position—AF more frequent with posterolateral in comparison with lateral CS lead position (B = 5.159; p = 0.005). Conclusions: The results of our study provide new data on AF predictors in patients with HF subjected to CRT. There remains a permanent need for new predictors, which might help in patient selection and improvement in response rate.

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Section: Discussionmentioning

confidence: 99%

Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy

Grbović,

Pavlović,

Žugić

2023

Medicina

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“…Slow recruitment leads to longer duration studies which in turn increases costs as well as drop-out rates. Perhaps equally relevant is that AF patients tend to be under-represented in large clinical CRT trials ( 53 ). With the driving force behind the largest studies primarily involving commercial funding and/or sponsorship, industry partners may be less motivated to support trials in AF patients, where the beneficial effects of these devices is likely to be attenuated, and regulatory approvals for broad indications have already been granted on the basis of previous evidence.…”

Section: Discussionmentioning

confidence: 99%

The role of conduction system pacing in patients with atrial fibrillation

Wijesuriya

Mehta

Vere

et al. 2023

Front. Cardiovasc. Med.

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Conduction system pacing (CSP) has emerged as a promising novel delivery method for Cardiac Resynchronisation Therapy (CRT), providing an alternative to conventional biventricular epicardial (BiV) pacing in indicated patients. Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.

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“…Device detected AF in patients with HF necessitates prompt investigation. Furthermore, AF reduces the percentage of BIV pacing, which can diminish response to CRT (Elliott et al, 2021). Rhythm control if a candidate or rate control with medication or with AV node ablation should be pursued to achieve nearly 100% BIV pacing.…”

Section: Discussionmentioning

confidence: 99%

Early referrals save lives in advanced heart failure

Wu,

Nam,

Yurkova

et al. 2023

J Am Assoc Nurse Pract

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Heart failure (HF) is a chronic, progressive medical condition that can quickly cause deterioration of the patient's medical and functional status. Delay of HF diagnosis and improper treatment can lead to catastrophic patient outcomes. This case report describes a 62-year-old with HF with reduced ejection fraction secondary to nonischemic cardiomyopathy, s/p cardiac resynchronization therapy defibrillator in 2020. He presented to the emergency department for worsening shortness of breath and chest pain for 3 days and subsequently had cardiac arrest. The patient eventually underwent a successful implantation of left ventricular assist device as a bridge to transplant. Timely referral yields a better patient outcome. This case study illustrates a clinical pathway that can be used by primary care providers when considering referral of a patient with advanced HF (AHF) to an AHF center for management and possible advanced therapies.

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Atrial fibrillation in cardiac resynchronization therapy

Cited by 12 publications

References 70 publications

Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy

Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy

The role of conduction system pacing in patients with atrial fibrillation

Early referrals save lives in advanced heart failure

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