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AVJ ablation aids survival in CRT patients with HF and AF
8 July 2008
MedWire News: Adding atrioventricular junction (AVJ) ablation to cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and permanent atrial fibrillation (AF) may improve their survival, study findings suggest.
Permanent AF is a common arrhythmia in HF patients and is associated with increased morbidity and mortality, note Maurizio Gasparini (Istituto Clinico Humanitas Rozzano-Milano, Italy) and colleagues.
In a nonrandomized study, they set out to determine how CRT affects survival in HF patients, and whether AVJ ablation could influence long-term outcomes.
Using information collected in the Multicenter Longitudinal Observational Study (MILOS), they identified 1285 consecutive patients implanted with CRT devices, including 243 (19%) patients with permanent AF.
Rate control in AF was achieved by ablating the AVJ in 118 patients for whom the percentage of biventricular pacing from device counters at 2 months after implantation was less than 85%, with the remainder prescribed negative chronotropic drugs.
Over a median follow-up of 34 months, all-cause mortality was similar in patients who were in sinus rhythm and those with AF, at 8.4 versus 8.9 deaths per 100 person-years, respectively.
There were also no significant differences observed for cardiac mortality.
However, within the group of patients with AF, death rates were significantly lower in those who had undergone AVJ ablation than in those receiving drug treatment, at 4.3 versus 15.2 deaths per 100 person-years, respectively.
The adjusted hazard ratios for AVJ ablation versus AF drug treatment were 0.26 for all-cause mortality, 0.31 for cardiac mortality, and 0.15 for HF mortality.
"In HF patients with permanent AF, AVJ ablation in addition to CRT appears to improve long-term overall mortality compared with CRT alone, primarily by reducing HF death," they conclude in the European Heart Journal.
"AVJ ablation seems to be a fundamental adjunct to ensure adequate CRT delivery and thus reducing mortality in patients with permanent AF."
