IMPACT OF PERMANENT ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE, VENTRICULAR DYSSYNCHRONY AND INDICATION FOR CRT. REGISTER DATA WITH 1721 PATIENTS: 1999-2007

Objectives: Cardiac resynchronization therapy (CRT) has become treatment of choise in patients with refractory heart failure, depressed left ventricle ejection fraction(EF), and ventricular dyssynchrony.

Methods: 1721 consecutive patients were included in a single center register after implantation of CRT –P or –D between 1999-2007. We retrospectively analysed the impact of persistent AF ( group I) at the time of implantation on clinical improvement ( worse  = 0, no change = 1, much better = 3 points) compared with patients in SR ( group II) during the continuous follow-up.

Results: 372 patients (22%) presented with persistent AF (group I) and 1349 with SR ( group II) before CRT. Group I differed significantly from group II in age ( 73 ± 6  vs. 66 ± 8 y: p<0.05) gender ( Male 82% vs. 72%: p<0.05) and LA diameter ( 53 ± 6 vs. 45 ± 6 mm: p<0.05). No significant differences were observed regarding NYHA ( 3.2 ± 0.5 vs. 3.0 ± 0.4), LV EF ( 23 ± 8 vs. 25 ± 8%), LVEDD (66 ± 7 vs. 64 ± 11mm), BNP (1212 ± 871 vs. 965 ± 772 pg/ml), QRS with (166 ± 42 vs.157 ± 32 ms) and substrate ( CAD 62 vs. 57 %). During long-term FU ( 4.6 + 1.7 years) clinical improvement was similar in group I and II ( 2.4 + 0.7 vs.2.5 + 0.5), but there was higher mortality in group I ( 62/372 – 17 % vs. 121/1352 – 9 % : p <0.01. 42/372(11%) in group I presented with sinus rhythm 1 year after CRT implant and 221/372 (59%) were indicated for AVN-ablation because of BiV pacing < 90 %.

Conclusions: Patient with heart failure, ventricular dyssynchrony and permanent AF had a comparable clinical and objective improvements with CRT as those in SR. Restoration of SR in patients with persistent AF and decrease in mitral regurgitation might be one of the mechanisms of reverse LV remodeling. Nevertheless mortality in patients with severe heart failure and chronic AF remained high despite CRT.