Author + information
- Serkan Çay1,
- Fatih Uçar1,
- Ahmet Duran Demir2,
- Göksel Çağırcı3,
- Serkan Topaloğlu1,
- Dursun Aras1 and
- Sinan Aydoğdu1
Cardiac resynchronization therapy(CRT)is related with improved morbidity and mortality in left bundle branch block(LBBB)with and without atrial fibrillation(AF). No clear data is present in non-LBBB with AF.
Patients with AF and CRT (LBBB and non-LBBB) requiring atrioventricular node(AVN)ablation were assigned to AVN ablation and non-AVN ablation groups. Primary end-points were composite of all-cause mortality or heart failure hospitalization. Four-year follow-up was planned.
A total of 82 patients with CRT were included. Of these, 38 (46%) had LBBB with AF and 44 (54%) had non-LBBB with AF. Ablation was performed in 20 (24%) patients with LBBB and in 22(27%) with non-LBBB. The mean age was 65 years. Males were 83%. Ischemic etiology was 51% and mean AF duration was 32 months. In all population the primary end-point of all cause mortality or heart failure hospitalization was lower in AVN ablation patients compared with non-AVN ablation patients (6.1% vs. 18.3%, p=0.007), driven by reduction in both mortality (2.4% vs. 9.8%, p=0.035) and hospitalization (6.1% vs. 15.9%, p=0.024). In LBBB patients, the primary end-point was also lower in AVN ablation patients compared with non-AVN ablation patients (5.3% vs. 21.1%, p=0.016), driven by reduction in both mortality (0% vs. 10.5%, p=0.026) and hospitalization (5.3% vs. 18.4%, p=0.036). In non-LBBB patients, the primary end-point was 6.8% and 15.9% in AVN ablation group and non-AVN ablation group, respectively.However,this difference did not reach a statistical significance (p=0.150) (Figure).
The morbidity and mortality benefit of AVN ablation was demonstrated in heterogeneous group of patients with or without LBBB and AF.Subgroup analysis of patients with non-LBBB and AF did not, however, show the same benefit.