Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Mittal, Suneet; Musat, Dan; Hoskins, Michael; Prillinger, Julie B.; Roberts, Gregory J; Nabutovsky, Yelena; Merchant, Faisal M.

doi:10.1161/jaha.117.007270

Cited by 14 publications

(7 citation statements)

References 19 publications

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“…Finally, in a nationwide cohort similar to that used in the current study, over 4 years of follow-up, pacemaker patients with AF and concurrent AVJ ablation were associated with a significantly increased risk of HF hospitalization compared with matched pacemaker patients without an ablation. 22 Our data and the echocardiographic data from the PACE trial are consistent in demonstrating a relatively rapid detrimental effect of RV pacing on ventricular function, which can be discerned within the first several months. Although the mechanisms of this observed effect have not been fully elucidated, an acute analysis of 12 patients with normal LVEF and forced RV pacing using short AV delays demonstrated a significant drop in LVEF within 2 hours of RV pacing and progressive deterioration of ventricular function after a week of RV pacing.…”

Section: Discussionsupporting

confidence: 80%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background-Although right ventricular pacing can contribute to cardiomyopathy, the impact of complete atrioventricular block (cAVB) on heart failure (HF) development in pacemaker patients has not been well characterized. We evaluated the incidence and time course for developing HF after pacemaker implantation for cAVB. Methods and Results-A MarketScan database identified patients undergoing dual-chamber pacemaker implantation from 2008 to 2014. Patients with cAVB were identified by an atrioventricular node ablation or diagnosis of third-degree AVB.Patients with ≥1 year of continuous MarketScan enrollment before and after implant and without a previous diagnosis of HF were dichotomized into those with cAVB and without AVB. The primary end point was new HF assessed over acute (0-6 months) and chronic (6 months to 4 years) phases post-pacemaker implantation. The cohort included 6994 cAVB patients and 14 208 patients without AVB, followed for 2.35 years (interquartile range, 1.62-3.39 years). After adjustment for baseline covariates, patients with cAVB experienced an increased risk of new-onset HF in the acute phase (hazard ratio, 1.62; 95% confidence interval, 1.48-1.79; P<0.001). Although the risk of HF remained elevated among those with cAVB in the chronic phase, the effect was attenuated (hazard ratio, 1.16; 95% confidence interval, 1.08-1.25; P<0.001). After pacemaker implantation, younger patients (≤55 years of age) and those with an antecedent history of atrial fibrillation experienced the highest risk of HF associated with cAVB. Conclusions-Patients with a diagnosis of cAVB, and thus presumed to have a higher burden of right ventricular pacing, experienced an increased risk of new-onset HF after pacemaker implantation compared with those without AVB. Better tools are needed to identify patients at high risk of developing HF in the setting of right ventricular pacing and to determine whether these patients benefit from upfront biventricular pacing. Study PopulationPatients were selected for study inclusion if they were implanted with a de novo dual-chamber pacemaker (Current Procedural Terminology code 33208 and Healthcare Common Procedure Coding System codes C1785 and C2619) from any manufacturer between April 1, 2008, and March 31, 2014. Patients with a left ventricular lead placed (Current Procedural Terminology codes 33224 or 33225) at the time of pacemaker implantation were excluded. De novo implants were identified as pacemaker patients without a previous device implantation and without a remote or in-office pacemaker follow-up visit in the 1 year before implantation. An enrollment indicator confirmed active inclusion in the MarketScan databases for each patient per month. Patients were required to have at least 1 year of continuous enrollment in the MarketScan database before and after pacemaker implantation and to be ≥18 and ≤100 years of age at the time of pacemaker implantation.To evaluate the impact of atrioventricular block (AVB) on the development of HF after pacemaker implantation, patients wi...

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Section: Discussionsupporting

confidence: 80%

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Merchant

Hoskins

Musat

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…For patients with the same indications, biventricular pacing was only reported to result in a slight increase in LVEF (3.3%‐6.6%) . Compared to right ventricular pacing, biventricular pacing was associated with significant improvement in symptoms, but not 6‐min walk distance or overall mortality . Since no comparative study between HBP and biventricular or right ventricular pacing has been reported, we cannot draw any conclusion on the superiority of HBP over biventricular pacing at the present time.…”

Section: Discussionmentioning

confidence: 77%

“…20 Compared to right ventricular pacing, biventricular pacing was associated with significant improvement in symptoms, but not 6-min walk distance or overall mortality. 21 Since no comparative study between HBP and biventricular or right ventricular pacing has been reported, we cannot draw any conclusion on the superiority of HBP over biventricular pacing at the present time. Another population that could potentially benefit from HBP is heart failure patients with PR prolongation and narrow QRS com-plex.…”

Section: Discussionmentioning

confidence: 78%

Permanent His bundle pacing in heart failure patients: A systematic review and meta‐analysis

Zhang

Zou

Wang

et al. 2018

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) is the standard‐of‐care therapy for the patients with heart failure and left ventricular (LV) dyssynchrony. However, approximately 30% of the patients show no response. Recent studies have shown that His bundle pacing (HBP) could be an alternative for the patients with CRT indications. The purpose of this study was to evaluate the efficacy of HBP in patients with heart failure. Methods We searched PubMed and Embase databases for studies evaluating HBP in patients with heart failure and LV dyssynchrony. The successful rate of implantation, QRS duration, pacing threshold, LV function at baseline and follow‐up, and mortality rates were extracted and summarized. Results Eleven studies including 494 patients were included in this analysis. The overall successful rate for implantation was 82.4%. The main indications for HBP were CRT candidates and cardiomyopathy with atrial fibrillation undergoing atrioventricular node ablation. Permanent HBP resulted in narrow QRS duration of 116.3 ± 13.9 ms after implantation. LV functions, including echocardiographic parameters and clinical outcomes, significantly improved at follow‐up (P < 0.001). However, there was a trend of increased capture and bundle branch block correction thresholds at follow‐up compared to baseline (P = 0.01 and 0.02, respectively). During a mean follow‐up of 23.7 months, 5.9% of the patients experienced heart failure‐related hospitalization and the mortality rate was 9.1%. Conclusion Permanent HBP has shown promising results for heart failure patients in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

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“…It and can also decrease the number of HF hospitalizations. 132,133 Advanced treatment for heart failure…”

Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

Acoustic and afterload evaluation of left ventricular assist devices

Sundbom

2019

Linköping University Medical Dissertations

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Pulse width modulation RAAS Renin-Angiotensin Aldosterone system ROS Reactive oxygen species RPM Revolutions per minute RV Right ventricular TGF-β Transforming growth factor-β vWf Von Willebrand factor HF Unable to carry on any physical activity without symptoms of HF, or symptoms of heart failure at rest Hypertension Arrythmias Tachyarrythmias Atrial and ventricular arrythmias Bradyarrythmias Sinus node dysfunction, conduction disorders Valve disease Congentinal Atrial and ventricular septum defects Acquired Aortic, mitral, pulmonary and tricuspid valve disease High output Anemia, pregnancy, thyreotoxicosis, sepsis Volume overload Renal failure, iatrogen volume overload Others Pericardial Constrictive pericarditis, pericardial effusion Endomyocardial

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Clinical Outcomes After Ablation of the AV Junction in Patients With Atrial Fibrillation: Impact of Cardiac Resynchronization Therapy

Cited by 14 publications

References 19 publications

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing

Permanent His bundle pacing in heart failure patients: A systematic review and meta‐analysis

Acoustic and afterload evaluation of left ventricular assist devices

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