Europace Advance Access originally published online on May 28, 2008
Europace 2008 10(7):809-815; doi:10.1093/europace/eun135
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Cardiac resynchronisation therapy
Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation
Hospital Santa Cruz—Av. Prof. Reynaldo dos Santos, 2794-035 Carnaxide, Portugal
Aims: To assess the clinical benefit of cardiac resynchronization therapy (CRT) in patients with atrial fibrillation (AF) compared with patients in sinus rhythm (SR), and to evaluate the impact of atrioventricular junction (AVJ) ablation on the outcome of AF patients undergoing CRT.
Methods and results: We conducted a retrospective analysis of 131 consecutive heart failure (HF) patients who underwent CRT implantation. Three groups were considered: SR (n = 78), AF with AVJ ablation (n = 26), and AF without AVJ ablation (n = 27). Patients were evaluated for the occurrence of cardiac death, hospitalization for HF, and responsiveness to CRT (survival with improvement of 
1 New York Heart Association class at 6 months). The three groups showed a significant improvement in functional class. However, the proportion of responders was significantly lower in AF patients without AVJ ablation (52 vs. 79% in SR and 85% in AF with AVJ ablation, P < 0.008). Atrial fibrillation without AVJ ablation was also independently associated with mortality (HR 5.22, 95% CI: 1.60–17.01, P = 0.006) and hospitalization for HF during the first 12 months (HR 6.23, 95% CI: 2.09–18.54, P = 0.001). The outcomes of AF with AVJ ablation patients were similar to the outcomes of patients in SR.
Conclusion: Sinus rhythm and AF patients display similar survival and clinical improvement after CRT implantation, provided that AVJ ablation is performed in the latter.
Key Words: Heart failure, Cardiac resynchronization, Atrial fibrillation, Atrioventricular junction ablation
* Corresponding author. Tel: +351 210433129; fax: +351 214188095 E-mail address: miguelferreira.md{at}sapo.pt
Manuscript submitted 31 October 2007. Accepted after revision 8 February 2008.
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