Association of Rate-Controlled Persistent Atrial Fibrillation With Clinical Outcome and Ventricular Remodelling in Recipients of Cardiac Resynchronization Therapy

作者：Wilton Stephen B^*; Kavanagh Katherine M; Aggarwal Sandeep G; Philippon Francois; Yee Raymond; Cowan Karen; Exner Derek V

来源：Canadian Journal of Cardiology, 2011, 27(6): 787-793.

DOI：10.1016/j.cjca.2011.06.004

Background: Whether patients with persistent atrial fibrillation (AF) obtain the same degree of benefit with cardiac resynchronization therapy (CRT) as those in sinus rhythm remains unclear.
Methods: We enrolled 93 patients undergoing CRT implantation, 20 (22%) of whom had rate-controlled persistent AF. The primary end-point was CRT response defined as 1 class improvement in Specific Activity Scale and 15% reduction in left ventricular end-systolic volume (LVESV) during 12 months. Other endpoints included changes in 6-minute walk distance, quality of life, B-type natriuretic peptide, and survival.
Results: Baseline characteristics were similar in those with and without AF. Response to CRT was observed in 42% vs 54% of those with and without AF, respectively (P = 0.3). Both groups had significant improvements in 6-minute walk distance, quality of life, and LVESV, but the improvement in LVESV was smaller in those with AF (13.7% +/- 14.9% vs 27.7% +/- 23.7%; P = 0.02). During 2.8 +/- 1.4 years of follow-up, AF was associated with a 2.2-fold increased risk of death or transplantation (95% confidence interval, 1.2-3.9; P = 0.01).
Conclusions: Compared with patients without rate-controlled persistent AF, those with rate-controlled persistent AF had similar rates of clinical improvement but less left ventricular reverse remodelling in the first year after CRT. AF was associated with a markedly higher risk of death or transplantation in long-term follow-up. Given these findings, randomized studies assessing CRT efficacy in those with AF are warranted.

• 出版日期2011-12