Results of the multicenter CONTAK RENEWAL 3 AVT clinical study of cardiac resynchronization defibrillator therapy in patients with atrial fibrillation

Saxon, Leslie A.; Crandall, Brian G.; Nydegger, Charles; Genderen, Rhonda Van; Greenfield, Ruth Ann

doi:10.1016/j.hrthm.2005.02.067

Cited by 2 publications

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“…All studies were available as full text. Six studies were excluded: one due to lack of a control group44; second compared outcomes based on ventricular rates in CRT-AF patients3; third did not provide outcomes specifically for the CRT and ICD subsets of the study population with and without AF45; the fourth compared patients with ischaemic and non-ischaemic cardiomyopathy with AVJ ablation and CRT placement46; and the last two tested only short-term LV functional parameters 47 48. There were 30 263 patients with AF, of which 25 791 had CRT.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies

et al. 2019

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BackgroundCardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF)Methods and resultsLiterature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).ConclusionThe results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.

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