Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy:Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations

Abstract

Aims: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs. Methods and results: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF+AVJA) and 402 (12%) treated with rate-slowing drugs (AF+Drugs). Median follow-up was 18months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF+AVJA, 43.6 (37.7-50.4) in AF+Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF+AVJA vs. AF+Drugs (P<0.001) and 0.48 (0.35-0.66) for AF+AVJA vs. SR (P<0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P<0.001, vs. AF+Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P<0.001, vs. AF+Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF+AVJA vs. AF+Drugs [IRR 0.57 (0.41-0.79), P<0.001] and SR [IRR 0.85 (073-0.98), P=0.027]. Conclusion: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.

Publication DOI: https://doi.org/10.1002/ejhf.1117
Divisions: College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG)
College of Health & Life Sciences > Aston Medical School
Additional Information: Copyright © 2017 by John Wiley & Sons. This is the peer reviewed version of the following article: Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations Gasparini, M., Kloppe, A., Lunati, M., Anselme, F., Landolina, M., Martinez-Ferrer, J. B., Proclemer, A., Morani, G., Biffi, M., Ricci, R., Rordorf, R., Mangoni, L., Manotta, L., Grammatico, A., Leyva, F. & Boriani, G. 18 Dec 2017 In : European Journal of Heart Failure., which has been published in final form at https://doi.org/10.1002/ejhf.1117. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Uncontrolled Keywords: Atrial fibrillation,Atrioventricular junction ablation,Cardiac resynchronization therapy,Heart failure,Cardiology and Cardiovascular Medicine
Publication ISSN: 1879-0844
Last Modified: 04 Mar 2024 08:24
Date Deposited: 10 Jan 2018 14:15
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://onlinel ... .1002/ejhf.1117 (Publisher URL)
PURE Output Type: Article
Published Date: 2018-10-10
Published Online Date: 2017-12-18
Accepted Date: 2017-11-20
Authors: Gasparini, Maurizio
Kloppe, Axel
Lunati, Maurizio
Anselme, Frédéric
Landolina, Maurizio
Martinez-Ferrer, Jose Bautista
Proclemer, Alessandro
Morani, Giovanni
Biffi, Mauro
Ricci, Renato
Rordorf, Roberto
Mangoni, Lorenza
Manotta, Laura
Grammatico, Andrea
Leyva, Francisco
Boriani, Giuseppe

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