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 and Boriani, Giuseppe (2018). Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy:Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations. European Journal of Heart Failure, 20 (10), pp. 1472-1481.
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 |
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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: | 06 Aug 2024 07:54 |
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 |