کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2923445 1175874 2010 6 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی کاردیولوژی و پزشکی قلب و عروق
پیش نمایش صفحه اول مقاله
Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy
چکیده انگلیسی

BackgroundCardiac 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.ObjectiveThe 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.MethodsOf 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).ResultsCRT 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.ConclusionAmong 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.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Heart Rhythm - Volume 7, Issue 9, September 2010, Pages 1240–1245
نویسندگان
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