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Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study

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Abstract

Background

We examined the long-term (≥ 5 years) outcomes of dual-site atrial pacing (DAP) when added to background antiarrhythmic drugs (AADs) and/or ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF).

Methods

Seventy-three patients with HF (mean NYHA HF class of 2.5) and AF refractory to AADs and/or ablation were implanted with DAP systems to achieve biatrial electrical and mechanical resynchronization (ART) and rhythm control (RC).

Results

Thirty-eight patients with refractory AF and HF with preserved ejection fraction (HFpEF) and 35 with reduced ejection fraction (HFrEF) were enrolled. HFpEF patients had higher left ventricular ejection fraction compared to HFrEF (53 ± 5 vs. 31 ± 10% p < 0.001). Median follow-up for survival was 9.3 years (mean 9.0 years, SE 0.63) and was similar across subgroups (p = 0.127). After DAP, 87% maintained RC with improvement in NYHA HF class (mean 1.8) at 3 years. RC was similar in HFpEF compared with HFrEF patients (89 vs. 85% respectively, p = NS) and in paroxysmal versus persistent AF (90 vs. 85% respectively, p = NS). Total survival was superior in HFpEF compared HFrEF patients (75% in HFpEF vs. 45% in HFrEF at 5 years, and 60% in HFpEF vs. 34% in HFrEF at 10 years, p = 0.036). Survival trended to be better in patients with RC than those without RC (75 vs. 54% respectively at 5 years, p = .13).

Conclusions

ART using DAP as add on therapy improved HF and established long-term RC in many patients with HFrEF and HFpEF with refractory AF. Long-term survival rates were superior in HFpEF than HFrEF.

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Funding

This study has been supported by the Electrophysiology Research Foundation alone with no funding from other sources.

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Authors and Affiliations

  1. Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA

    Sanjeev Saksena, April Slee & Marwan Saad

  2. Rutgers’- Robert Wood Johnson Medical School, Piscataway, NJ, USA

    Sanjeev Saksena, April Slee & Marwan Saad

Authors
  1. Sanjeev Saksena
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  2. April Slee
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Correspondence to Sanjeev Saksena.

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Conflict of interest

Dr. Saksena has been a consultant to NIH, member of the TOPCAT trial steering committee, consultant to pharmaceutical and device manufacturers but has no direct conflicts with the subject of this study.

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Saksena, S., Slee, A. & Saad, M. Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study. J Interv Card Electrophysiol 53, 9–17 (2018). https://doi.org/10.1007/s10840-018-0408-1

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  • DOI: https://doi.org/10.1007/s10840-018-0408-1

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