Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations

Maurizio Gasparini*, Axel Kloppe, Maurizio Lunati, Frédéric Anselme, Maurizio Landolina, Jose Bautista Martinez-Ferrer, Alessandro Proclemer, Giovanni Morani, Mauro Biffi, Renato Ricci, Roberto Rordorf, Lorenza Mangoni, Laura Manotta, Andrea Grammatico, Francisco Leyva, Giuseppe Boriani

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Aims: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs. Methods and results: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF+AVJA) and 402 (12%) treated with rate-slowing drugs (AF+Drugs). Median follow-up was 18months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF+AVJA, 43.6 (37.7-50.4) in AF+Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF+AVJA vs. AF+Drugs (P<0.001) and 0.48 (0.35-0.66) for AF+AVJA vs. SR (P<0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P<0.001, vs. AF+Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P<0.001, vs. AF+Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF+AVJA vs. AF+Drugs [IRR 0.57 (0.41-0.79), P<0.001] and SR [IRR 0.85 (073-0.98), P=0.027]. Conclusion: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Early online date18 Dec 2017
DOIs
Publication statusPublished - 18 Dec 2017

Bibliographical note

Copyright © 2017 by John Wiley & Sons. This is the peer reviewed version of the following article: Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations
Gasparini, M., Kloppe, A., Lunati, M., Anselme, F., Landolina, M., Martinez-Ferrer, J. B., Proclemer, A., Morani, G., Biffi, M., Ricci, R., Rordorf, R., Mangoni, L., Manotta, L., Grammatico, A., Leyva, F. & Boriani, G. 18 Dec 2017 In : European Journal of Heart Failure., which has been published in final form at https://doi.org/10.1002/ejhf.1117. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Keywords

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

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    Gasparini, M., Kloppe, A., Lunati, M., Anselme, F., Landolina, M., Martinez-Ferrer, J. B., Proclemer, A., Morani, G., Biffi, M., Ricci, R., Rordorf, R., Mangoni, L., Manotta, L., Grammatico, A., Leyva, F., & Boriani, G. (2017). Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: Positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.1117