PMID- 20156595
OWN - NLM
STAT- MEDLINE
DCOM- 20110125
LR  - 20201216
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 7
IP  - 9
DP  - 2010 Sep
TI  - Atrioventricular nodal ablation predicts survival benefit in patients with atrial 
      fibrillation receiving cardiac resynchronization therapy.
PG  - 1240-5
LID - 10.1016/j.hrthm.2010.02.011 [doi]
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%) for-AVN-ABL 
      group (P = .008). AVN ablation was independently associated with survival benefit 
      from death (hazard ratio [HR] 0.13, 95% CI 0.03-0.58, P = .007) and from combined 
      death, heart transplant, and left ventricular assist device (HR 0.19, 95% CI 
      0.06-0.62, 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.
CI  - Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights 
      reserved.
FAU - Dong, Kan
AU  - Dong K
AD  - Department of Cardiology, First Affiliated Hospital, Zhejiang University School 
      of Medicine, Hangzhou, China.
FAU - Shen, Win-Kuang
AU  - Shen WK
FAU - Powell, Brian D
AU  - Powell BD
FAU - Dong, Ying-Xu
AU  - Dong YX
FAU - Rea, Robert F
AU  - Rea RF
FAU - Friedman, Paul A
AU  - Friedman PA
FAU - Hodge, David O
AU  - Hodge DO
FAU - Wiste, Heather J
AU  - Wiste HJ
FAU - Webster, Tracy
AU  - Webster T
FAU - Hayes, David L
AU  - Hayes DL
FAU - Cha, Yong-Mei
AU  - Cha YM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20100213
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/mortality/physiopathology/*therapy
MH  - Atrioventricular Node/physiopathology/*surgery
MH  - Cardiac Resynchronization Therapy/*methods
MH  - Catheter Ablation/*methods
MH  - Electrophysiologic Techniques, Cardiac
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2010/02/17 06:00
MHDA- 2011/01/28 06:00
CRDT- 2010/02/17 06:00
PHST- 2009/06/17 00:00 [received]
PHST- 2010/02/05 00:00 [accepted]
PHST- 2010/02/17 06:00 [entrez]
PHST- 2010/02/17 06:00 [pubmed]
PHST- 2011/01/28 06:00 [medline]
AID - S1547-5271(10)00116-5 [pii]
AID - 10.1016/j.hrthm.2010.02.011 [doi]
PST - ppublish
SO  - Heart Rhythm. 2010 Sep;7(9):1240-5. doi: 10.1016/j.hrthm.2010.02.011. Epub 2010 
      Feb 13.