Probability of sinus rhythm conversion and maintenance in cardiac resynchronization therapy patients with atrial fibrillation during 5‐year follow‐up

Abstract

Introduction There is a high prevalence of atrial fibrillation (AF) in patients with heart failure presented for cardiac resynchronization therapy (CRT). It remains unclear whether an atrial lead should be implanted in these patients. We, therefore, analyzed outcomes and course of rhythm in AF patients undergoing CRT implantation during long‐term follow‐up. Methods and Results Between 2004 and 2018, 328 consecutive patients with a history of AF receiving CRT implantation were included in this study. 132 patients had preoperatively paroxysmal AF (px‐AF), while 70 and 126 patients had persistent AF (ps‐AF) and long‐standing persistent AF (lp‐AF), respectively. The outcome data were collected in our institutional database and analyzed retrospectively. Two hundred and seventy‐seven patients received an atrial lead at the time of implantation, nine during follow‐up. No major lead implantation‐associated complications were observed. In patients with px‐AF, sinus rhythm (SR) was present in 78.8% at admission, 95.5% (p < .001) at discharge, and 85.7% (p = .965) after 5 years. In ps‐AF patients SR was present in 28.6%, 91.4% (p < .001) and 69.7% (p < .001), while all lp‐AF patients showed AF at admission and had SR rate of 50.8% (p < .001) at discharge and 44.1% after 5 years (p < .001). Conclusion We observed a high rate of conversion and long‐term persistence of SR in AF patients undergoing CRT implantation. Due to the low rate of lead implantation‐associated complications and the high successful SR conversion rates, we recommend the implantation of an atrial lead in CRT patients with AF.

Cardiac resynchronization therapy defibrillators in patients with permanent atrial fibrillation

“… 18 Recently, a high rate of sinus rhythm conversion and maintenance was reported in a cohort of 328 CRT patients, 44% of whom were found in sinus rhythm at 5 year follow‐up despite long‐lasting persistent AF in all patients at the time of device implantation. 19 These data raise the question of whether it is appropriate to implant the atrial lead despite overt permanent AF at CRT implantation. Assessing whether the risk of complications related to an apparently useless lead is balanced by the chance of spontaneous sinus rhythm recovery, may not be an easy task.…”

“…Ventricular remodelling may be at the origin of the sinus rhythm restoration and could facilitate a rhythm control strategy 18 . Recently, a high rate of sinus rhythm conversion and maintenance was reported in a cohort of 328 CRT patients, 44% of whom were found in sinus rhythm at 5 year follow‐up despite long‐lasting persistent AF in all patients at the time of device implantation 19 . These data raise the question of whether it is appropriate to implant the atrial lead despite overt permanent AF at CRT implantation.…”

Cardiac resynchronization therapy in patients with atrial fibrillation

“…In their published study, Ziegelhoeffer et al 9 investigated the outcomes of CRT placement with an atrial lead in patients with HF and AF. This was done by conducting a retrospective analysis of all patients with AF who received CRT for HF at the Kerckhoff Heart Center since June 2004 and were observed until July 2018—completing a 5‐year follow‐up.…”