PMID- 30273766
OWN - NLM
STAT- MEDLINE
DCOM- 20201009
LR  - 20201009
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 16
IP  - 3
DP  - 2019 Mar
TI  - Positive impact of pulmonary vein isolation on biventricular pacing in 
      nonresponders to cardiac resynchronization therapy.
PG  - 416-423
LID - S1547-5271(18)31011-7 [pii]
LID - 10.1016/j.hrthm.2018.09.028 [doi]
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) is less effective in patients 
      with atrial fibrillation (AF) because of impaired ventricular CRT capture. 
      OBJECTIVE: We investigated the effects of catheter ablation in patients with AF 
      and previous nonresponse to CRT. METHODS: Consecutive patients with AF and CRT 
      nonresponse who underwent catheter ablation for AF were analyzed. CRT nonresponse 
      was defined as one of the following: (1) reduced biventricular capture <95% due 
      to rapidly conducted AF, (2) <1 point improvement in New York Heart Association 
      (NYHA) class after CRT implantation, or (3) insufficient increase in left 
      ventricular ejection fraction (LVEF; </=5%) after CRT implantation. RESULTS: 
      Thirty-eight patients (8 women [21%]; mean age 68 +/- 10 years; LVEF 30% +/- 7%, 
      biventricular capture 88.0% [25th, 75th percentile 75.3%, 98.5%]) underwent 
      catheter ablation. One major and 1 minor complication occurred (1 lethal 
      atrioesophageal fistula and 1 hemodynamically nonrelevant pericardial effusion). 
      The Kaplan-Meier estimates for arrhythmia-free survival after single and multiple 
      ablation procedures were 29% (95% confidence interval 16%-51%) and 67% (95% 
      confidence interval 53%-86%) after 24 months. After a median follow-up of 817 
      days (25th, 75th percentile 179, 1741 days), biventricular capture and LVEF were 
      significantly higher (median [25th, 75th percentile] 99% [96%, 99%], difference 
      8% [0.2%, 3.75%], P < .0001; mean 32.1% +/- 9.1%, difference 2.2% +/- 7.1%, P = 
      .0225) and patients had a significantly lower functional NYHA class (28 of 37 
      patients with improvement of at least 1 point; P < .0001). CONCLUSION: Catheter 
      ablation of AF significantly improves CRT response in patients with heart failure 
      and concomitant AF in terms of increased biventricular capture and LVEF and 
      improved functional NYHA class.
CI  - Copyright (c) 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights 
      reserved.
FAU - Fink, Thomas
AU  - Fink T
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. 
      Electronic address: thomas_fink47@gmx.de.
FAU - Rexha, Enida
AU  - Rexha E
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Schluter, Michael
AU  - Schluter M
AD  - Asklepios Proresearch, Hamburg, Germany.
FAU - Lemes, Christine
AU  - Lemes C
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Maurer, Tilman
AU  - Maurer T
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Heeger, Christian-Hendrik
AU  - Heeger CH
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Reissmann, Bruno
AU  - Reissmann B
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Rottner, Laura
AU  - Rottner L
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Tonnis, Tobias
AU  - Tonnis T
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Ujeyl, Amaar
AU  - Ujeyl A
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Kruger, Matthias
AU  - Kruger M
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Portz, Nathaniel
AU  - Portz N
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Wohlmuth, Peter
AU  - Wohlmuth P
AD  - Asklepios Proresearch, Hamburg, Germany.
FAU - Mathew, Shibu
AU  - Mathew S
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Ouyang, Feifan
AU  - Ouyang F
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Rillig, Andreas
AU  - Rillig A
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Kuck, Karl-Heinz
AU  - Kuck KH
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
FAU - Metzner, Andreas
AU  - Metzner A
AD  - Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
LA  - eng
PT  - Journal Article
DEP - 20180929
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Aged
MH  - Atrial Fibrillation/physiopathology/*therapy
MH  - *Cardiac Resynchronization Therapy
MH  - *Catheter Ablation
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Pulmonary Veins
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Atrial fibrillation
OT  - Cardiac resynchronization therapy
OT  - Catheter ablation
OT  - Heart failure
OT  - Pulmonary vein isolation
EDAT- 2018/10/03 06:00
MHDA- 2020/10/10 06:00
CRDT- 2018/10/02 06:00
PHST- 2018/08/02 00:00 [received]
PHST- 2018/10/03 06:00 [pubmed]
PHST- 2020/10/10 06:00 [medline]
PHST- 2018/10/02 06:00 [entrez]
AID - S1547-5271(18)31011-7 [pii]
AID - 10.1016/j.hrthm.2018.09.028 [doi]
PST - ppublish
SO  - Heart Rhythm. 2019 Mar;16(3):416-423. doi: 10.1016/j.hrthm.2018.09.028. Epub 2018 
      Sep 29.