Abstract 3374: Four Year Survival in 1285 Patients Undergoing Cardiac Resynchronization Therapy (CRT): The Importance of Atrioventricular Junction Ablation in Patients with Permanent Atrial Fibrillation
Aim: To investigate the long-term effects of cardiac resynchronization therapy on all-cause survival of heart failure (HF) patients with permanent atrial fibrillation (AF).
Methods: From the experience of 4 European Centers, 1285 patients were implanted with CRT devices from August 1995 to August 2004: 1042 pts were in sinus rhythm (SR) and 243 (19 %) patients in AF. Rate control in AF patients was achieved either by ablating the atrioventricular junction (AVJ) in 118 patients (AFabl group), or by prescribing chronotropic-negative drugs (125 patients, AFnoabl). Clinical, demographic, and cumulative survival data were collected for the 3 separate groups.
Results: Median follow-up was 24 months (IQR: 10 – 40 months). At baseline, AFabl patients were older (p<.001), less frequently implanted with a CRT-D device (p<.002), more often had CAD etiology, while AFnoabl patients had lower EF (p<.001) and longer QRS (p<.001). During follow up, 170 deaths occurred for SR, 28 for AFnoabl, and 11 for AFabl, with a mortality rate of 8.4%/yr, 15.2%/yr, and 4.3%/yr respectively. Kaplan-Meier estimates (see Figure⇓) and Cox hazard’s ratio (HR) analysis showed that Afnoabl patients presented a significantly worse outcome (HR AFabl vs AFnoabl: 0.32 [0.15– 0.66], p=.002; Afnoabl vs SR 1.78 (1.18–2.69), p=.006) compared to the other 2 groups; results remained unchanged after adjusting for center, baseline age, gender, EF, and QRS duration (HR AFabl vs AFnoabl: 0.15 [0.05– 0.43], p<.001; Afnoabl vs SR 1.85 (1.11–3.08), p=0.018).
Conclusions: In patients with AF undergoing CRT, AVJ ablation conferred significant lower long-term all-cause mortality rate.