Results of the Multicenter RENEWAL^® 3 AVT Clinical Study of Cardiac Resynchronization Defibrillator Therapy in Patients with Paroxysmal Atrial Fibrillation

Abstract

In CRT-D candidates with a history of AF, 25% experience recurrent AF within 6 months of implant. Atrial detection and ventricular detection, shock, and resynchronization therapies are not compromised by the addition of atrial therapies to a CRT-D device.

Atrial fibrillation in cardiac resynchronization recipients with and without prior arrhythmic history. How much of arrhythmia is too much?

“…Several studies analyzed device-stored data to assess the incidence of AF in CRT patients [5,[8][9][10][11][12][13][14][15][16][17]. However, in the great majority of them + p < 0.05 vs. group with AF during follow-up; #79 patients survived the 24-month period: 10 with and 69 without AF history prior to cardiac resynchronization therapy.…”

Atrial Fibrillation Therapy in Patients with a CRT Defibrillator with Wireless Telemetry

“…This is especially the case when patient‐activated therapy has been used with a sedative 39,40 or when the shocks were preferentially administered at night 41 . There have been few reports of the efficacy of atrial shock therapies in patients with CRT‐D devices 12 …”

“…An analysis of the Framingham data demonstrated that heart failure was associated with approximately a five‐fold increased risk of AF 8,9 . The large randomized controlled trials of cardiac resynchronization therapy (CRT) excluded patients with AF in an attempt to study purely the effect of cardiac resynchronization 10–12 . Prior studies of patients with cardiac resynchronization defibrillators have shown that AF is common 13 .…”

“…Atrial shock therapy with or without sedation has been demonstrated to be very efficacious and surprisingly well tolerated in patients with single‐chamber, dual‐chamber, or atrial defibrillators 15–18 . However, ICD‐based atrial shock therapy has not been extensively studied in patients with CRT defibrillators 12,19–21 …”

Treatment of atrial fibrillation with a dual defibrillator in heart failure patients (TRADE HF): protocol for a randomized clinical trial

“…In light of this, early AF treatment could be reserved even for those patients with a lower AF burden or for those with no history of AF. A recent work by Saxon et al reports that 25% of CRT candidates with a history of AF, experience recurrent AF within 6 months of implant [38]. Given the high prevalence of AF in patients currently indicated to CRT, and the opportunity to treat new onset AF promptly, the inclusion criteria of the TRADE HF study consider all patients implanted with a biventricular device with defibrillator, regardless of their atrial arrhythmic history.…”