Atrial fibrillation in cardiac resynchronization therapy

TY - JOUR

T1 - Atrial fibrillation in cardiac resynchronization therapy

AU - Elliott, Mark K

AU - Mehta, Vishal S

AU - Martic, Dejana

AU - Sidhu, Baldeep S

AU - Niederer, Steven

AU - Rinaldi, Christopher A

PY - 2021/12/17

Y1 - 2021/12/17

N2 - Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort. [Abstract copyright: © 2021 Heart Rhythm Society. Published by Elsevier Inc.]

AB - Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort. [Abstract copyright: © 2021 Heart Rhythm Society. Published by Elsevier Inc.]

KW - AF ablation

KW - Rate control

KW - Atrial fibrillation

KW - Pulmonary vein isolation

KW - Rhythm control

KW - AV node ablation

KW - Cardiac resynchronization therapy

U2 - 10.1016/j.hroo.2021.09.003

DO - 10.1016/j.hroo.2021.09.003

M3 - Article

C2 - 34988530

SN - 2666-5018

VL - 2

SP - 784

EP - 795

JO - Heart Rhythm O2

JF - Heart Rhythm O2

IS - 6 Part B

ER -