Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy

Kan Dong, Win Kuang Shen, Brian D. Powell, Ying Xu Dong, Robert F. Rea, Paul Andrew Friedman, David O. Hodge, Heather J. Wiste, Tracy Webster, David L. Hayes, Yong-Mei Cha

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Abstract

Background: Cardiac resynchronization therapy (CRT) benefits patients with advanced heart failure. The role of atrioventricular nodal (AVN) ablation in improving CRT outcomes, including survival benefit in CRT recipients with atrial fibrillation, is uncertain. Objective: The purpose of this study was to assess the impact of AVN ablation on clinical and survival outcomes in a large atrial fibrillation and heart failure population that met the current indication for CRT and to determine whether AVN ablation is an independent predictor of survival in CRT recipients. Methods: Of 154 patients with atrial fibrillation who received CRT-D, 45 (29%) underwent AVN ablation (+AVN-ABL group), whereas 109 (71%) received drug therapy for rate control during CRT (-AVN-ABL group). New York Heart Association (NYHA) class, electrocardiogram, and echocardiogram were assessed before and after CRT. Survival data were obtained from the national death and location database (Accurint). Results: CRT comparably improved left ventricular ejection fraction (8.1% ± 10.7% vs 6.8% ± 9.6%, P = .49) and left ventricular end-diastolic diameter (-2.1 ± 5.9 mm vs -2.1 ± 6.7 mm, P = .74) in both +AVN-ABL and -AVN-ABL groups. Improvement in NYHA class was significantly greater in the +AVN-ABL group than in -AVN-ABL group (-0.7 ± 0.8 vs -0.4 ± 0.8, P = .04). Survival estimates at 2 years were 96.0% (95% confidence interval [CI] 88.6%100%) for +AVN-ABL group and 76.5% (95% CI 68.1%85.8%) forAVN-ABL group (P = .008). AVN ablation was independently associated with survival benefit from death (hazard ratio [HR] 0.13, 95% CI 0.030.58, P = .007) and from combined death, heart transplant, and left ventricular assist device (HR 0.19, 95% CI 0.060.62, P = .006) after CRT. Conclusion: Among patients with atrial fibrillation and heart failure receiving CRT, AVN ablation for definitive biventricular pacing provides greater improvement in NYHA class and survival benefit. Larger-scale randomized trials are needed to assess the clinical and survival outcomes of this therapy.

Original languageEnglish (US)
Pages (from-to)1240-1245
Number of pages6
JournalHeart Rhythm
Volume7
Issue number9
DOIs
StatePublished - Sep 2010

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Cardiac Resynchronization Therapy
Atrial Fibrillation
Survival
Confidence Intervals
Heart Failure
Heart-Assist Devices
Stroke Volume
Electrocardiography

Keywords

  • Atrial fibrillation
  • Atrioventricular nodal ablation
  • Cardiac resynchronization therapy
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy. / Dong, Kan; Shen, Win Kuang; Powell, Brian D.; Dong, Ying Xu; Rea, Robert F.; Friedman, Paul Andrew; Hodge, David O.; Wiste, Heather J.; Webster, Tracy; Hayes, David L.; Cha, Yong-Mei.

In: Heart Rhythm, Vol. 7, No. 9, 09.2010, p. 1240-1245.

Research output: Contribution to journalArticle

Dong, Kan ; Shen, Win Kuang ; Powell, Brian D. ; Dong, Ying Xu ; Rea, Robert F. ; Friedman, Paul Andrew ; Hodge, David O. ; Wiste, Heather J. ; Webster, Tracy ; Hayes, David L. ; Cha, Yong-Mei. / Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy. In: Heart Rhythm. 2010 ; Vol. 7, No. 9. pp. 1240-1245.
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abstract = "Background: Cardiac resynchronization therapy (CRT) benefits patients with advanced heart failure. The role of atrioventricular nodal (AVN) ablation in improving CRT outcomes, including survival benefit in CRT recipients with atrial fibrillation, is uncertain. Objective: The purpose of this study was to assess the impact of AVN ablation on clinical and survival outcomes in a large atrial fibrillation and heart failure population that met the current indication for CRT and to determine whether AVN ablation is an independent predictor of survival in CRT recipients. Methods: Of 154 patients with atrial fibrillation who received CRT-D, 45 (29{\%}) underwent AVN ablation (+AVN-ABL group), whereas 109 (71{\%}) received drug therapy for rate control during CRT (-AVN-ABL group). New York Heart Association (NYHA) class, electrocardiogram, and echocardiogram were assessed before and after CRT. Survival data were obtained from the national death and location database (Accurint). Results: CRT comparably improved left ventricular ejection fraction (8.1{\%} ± 10.7{\%} vs 6.8{\%} ± 9.6{\%}, P = .49) and left ventricular end-diastolic diameter (-2.1 ± 5.9 mm vs -2.1 ± 6.7 mm, P = .74) in both +AVN-ABL and -AVN-ABL groups. Improvement in NYHA class was significantly greater in the +AVN-ABL group than in -AVN-ABL group (-0.7 ± 0.8 vs -0.4 ± 0.8, P = .04). Survival estimates at 2 years were 96.0{\%} (95{\%} confidence interval [CI] 88.6{\%}100{\%}) for +AVN-ABL group and 76.5{\%} (95{\%} CI 68.1{\%}85.8{\%}) forAVN-ABL group (P = .008). AVN ablation was independently associated with survival benefit from death (hazard ratio [HR] 0.13, 95{\%} CI 0.030.58, P = .007) and from combined death, heart transplant, and left ventricular assist device (HR 0.19, 95{\%} CI 0.060.62, P = .006) after CRT. Conclusion: Among patients with atrial fibrillation and heart failure receiving CRT, AVN ablation for definitive biventricular pacing provides greater improvement in NYHA class and survival benefit. Larger-scale randomized trials are needed to assess the clinical and survival outcomes of this therapy.",
keywords = "Atrial fibrillation, Atrioventricular nodal ablation, Cardiac resynchronization therapy, Heart failure",
author = "Kan Dong and Shen, {Win Kuang} and Powell, {Brian D.} and Dong, {Ying Xu} and Rea, {Robert F.} and Friedman, {Paul Andrew} and Hodge, {David O.} and Wiste, {Heather J.} and Tracy Webster and Hayes, {David L.} and Yong-Mei Cha",
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T1 - Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy

AU - Dong, Kan

AU - Shen, Win Kuang

AU - Powell, Brian D.

AU - Dong, Ying Xu

AU - Rea, Robert F.

AU - Friedman, Paul Andrew

AU - Hodge, David O.

AU - Wiste, Heather J.

AU - Webster, Tracy

AU - Hayes, David L.

AU - Cha, Yong-Mei

PY - 2010/9

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N2 - Background: Cardiac resynchronization therapy (CRT) benefits patients with advanced heart failure. The role of atrioventricular nodal (AVN) ablation in improving CRT outcomes, including survival benefit in CRT recipients with atrial fibrillation, is uncertain. Objective: The purpose of this study was to assess the impact of AVN ablation on clinical and survival outcomes in a large atrial fibrillation and heart failure population that met the current indication for CRT and to determine whether AVN ablation is an independent predictor of survival in CRT recipients. Methods: Of 154 patients with atrial fibrillation who received CRT-D, 45 (29%) underwent AVN ablation (+AVN-ABL group), whereas 109 (71%) received drug therapy for rate control during CRT (-AVN-ABL group). New York Heart Association (NYHA) class, electrocardiogram, and echocardiogram were assessed before and after CRT. Survival data were obtained from the national death and location database (Accurint). Results: CRT comparably improved left ventricular ejection fraction (8.1% ± 10.7% vs 6.8% ± 9.6%, P = .49) and left ventricular end-diastolic diameter (-2.1 ± 5.9 mm vs -2.1 ± 6.7 mm, P = .74) in both +AVN-ABL and -AVN-ABL groups. Improvement in NYHA class was significantly greater in the +AVN-ABL group than in -AVN-ABL group (-0.7 ± 0.8 vs -0.4 ± 0.8, P = .04). Survival estimates at 2 years were 96.0% (95% confidence interval [CI] 88.6%100%) for +AVN-ABL group and 76.5% (95% CI 68.1%85.8%) forAVN-ABL group (P = .008). AVN ablation was independently associated with survival benefit from death (hazard ratio [HR] 0.13, 95% CI 0.030.58, P = .007) and from combined death, heart transplant, and left ventricular assist device (HR 0.19, 95% CI 0.060.62, P = .006) after CRT. Conclusion: Among patients with atrial fibrillation and heart failure receiving CRT, AVN ablation for definitive biventricular pacing provides greater improvement in NYHA class and survival benefit. Larger-scale randomized trials are needed to assess the clinical and survival outcomes of this therapy.

AB - Background: Cardiac resynchronization therapy (CRT) benefits patients with advanced heart failure. The role of atrioventricular nodal (AVN) ablation in improving CRT outcomes, including survival benefit in CRT recipients with atrial fibrillation, is uncertain. Objective: The purpose of this study was to assess the impact of AVN ablation on clinical and survival outcomes in a large atrial fibrillation and heart failure population that met the current indication for CRT and to determine whether AVN ablation is an independent predictor of survival in CRT recipients. Methods: Of 154 patients with atrial fibrillation who received CRT-D, 45 (29%) underwent AVN ablation (+AVN-ABL group), whereas 109 (71%) received drug therapy for rate control during CRT (-AVN-ABL group). New York Heart Association (NYHA) class, electrocardiogram, and echocardiogram were assessed before and after CRT. Survival data were obtained from the national death and location database (Accurint). Results: CRT comparably improved left ventricular ejection fraction (8.1% ± 10.7% vs 6.8% ± 9.6%, P = .49) and left ventricular end-diastolic diameter (-2.1 ± 5.9 mm vs -2.1 ± 6.7 mm, P = .74) in both +AVN-ABL and -AVN-ABL groups. Improvement in NYHA class was significantly greater in the +AVN-ABL group than in -AVN-ABL group (-0.7 ± 0.8 vs -0.4 ± 0.8, P = .04). Survival estimates at 2 years were 96.0% (95% confidence interval [CI] 88.6%100%) for +AVN-ABL group and 76.5% (95% CI 68.1%85.8%) forAVN-ABL group (P = .008). AVN ablation was independently associated with survival benefit from death (hazard ratio [HR] 0.13, 95% CI 0.030.58, P = .007) and from combined death, heart transplant, and left ventricular assist device (HR 0.19, 95% CI 0.060.62, P = .006) after CRT. Conclusion: Among patients with atrial fibrillation and heart failure receiving CRT, AVN ablation for definitive biventricular pacing provides greater improvement in NYHA class and survival benefit. Larger-scale randomized trials are needed to assess the clinical and survival outcomes of this therapy.

KW - Atrial fibrillation

KW - Atrioventricular nodal ablation

KW - Cardiac resynchronization therapy

KW - Heart failure

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