Abstract 13509: Cardiac Resynchronization Therapy in Patients With Atrial Fibrillation: The Certify Study
Objectives: To determine whether, in patients with atrial fibrillation (AF) undergoing cardiac resynchronization therapy (CRT), atrioventricular junction ablation (AVJA) is associated with a better outcome than treatment with rate-slowing drugs.
Background: Different trial demonstrated that CRT is effective in heart failure (HF) patients who are in sinus rhythm (SR). No trials addressed whether CRT confers similar benefits in AF patients , with/without AVJA.
Methods: The clinical outcome of CRT in patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) were compared with SR patients (n = 6,046).
Results: Median follow-up of 37 months: total (6.8 vs 6.1 per 100 person year) and cardiac mortality (4.2 vs 4.0) (both p = NS) were similar in patients with AF+AVJA and patients in SR. In contrast, the AF+drugs group had a higher total and cardiac mortality than the SR and the AF+AVJA groups (11.3 and 8.1 , respectively; p<0.001) (see Figure) On multivariable analysis, AF+AVJA had total (Hazard ratio [HR]: 0.93, 95% confidence interval [C.I.] 0.74-1.67) and cardiac mortality (HR: 0.88, 95% C.I. 0.66-1.17 ) similar to the SR group, independent of known confounders. AF+drugs group, however, had a higher total (HR: 1.52, 95% C.I. 1.26-1.82) and cardiac (HR: 1.57, 95% C.I. 1.27-1.94) mortality than both the SR and AF+AVJA groups (both p<0.001).
Conclusions: Long term survival after CRT in patients with AF+AVJA is similar to that observed in patients in SR. Mortality is higher in AF patients treated with rate-slowing drugs.
- © 2013 by American Heart Association, Inc.