Cardiac resynchronization therapy in the presence of total atrioventricular block reduces long‐lasting atrial fibrillation episodes

Abstract

Abstract Background There is an ongoing debate on how cardiac resynchronization therapy (CRT) in the presence of total AV block affects atrial fibrillation (AF) episodes and symptoms in patients with AF. Methods Seventy‐five patients with symptomatic, drug and ablation refractory AF received, irrespective of their left ventricular ejection fraction (EF), either a CRT device and underwent subsequent atrioventricular node (AVN) ablation or already had a total AV block and underwent CRT upgrade. Long‐lasting AF episodes (>48 h), left ventricular ejection fraction (LVEF), left ventricular end‐diastolic diameter (LVEDD), left atrial diameter (LAD), NTproBNP levels, EHRA score, and NYHA class had been monitored on the follow‐up. Results The number of patients experiencing long‐lasting AF episodes (>48 h) and symptoms decreased significantly within 24 months after CRT implantation in the presence of total AV block (p < .001) from 57 (76%) to 25 (33.3%). Mean LAD decreased from 52 mm (IQR 48.0–56.0) to 48 mm (IQR 42.0–52.0, p < .001) and LVEDD from 54 mm (IQR 49.0–58.0) to 51 mm (IQR 46.5–54.0, p < .001). Conclusion A combination of total AVN block and biventricular pacing markedly reduces long‐lasting AF episodes, symptoms, left atrial diameter, and left ventricular end‐diastolic diameter.

Keywords

• atrial fibrillation
• atrial fibrillation episodes
• atrioventricular node ablation
• CRT
• reverse remodeling