Cardiac Resynchronization Therapy (CRT) a Plus for Atrial Fibrillation Patients: Results from the CERTIFY Study

Long term survival after cardiac resynchronization therapy in patients with atrial fibrillation and atrioventricular junction ablation is similar to that observed in patients in sinus rhythm, but death rate is elevated for atrial fibrillation patients treated with rate-slowing drugs.

DALLAS -- Nov 18, 2013 -- Long term survival after cardiac resynchronization therapy (CRT) in patients with atrial fibrillation (AF) and atrioventricular junction ablation (AVJA) is similar to that observed in patients in sinus rhythm (SR), but death rate is elevated for AF patients treated with rate-slowing drugs, according to a study presented at the 2013 American Heart Association Scientific Sessions.

Mauizio Gasparini, MD, and colleagues from the IRCCS Istito Clinico Humanitas, Rozzaro, Italy, reported results of an analysis of the clinical outcomes associated with cardiac resynchonization therapy in patients with AF undergoing CRT.

The study was reported in a poster session on November 17, 2013.

According to Gasparini, “different trials demonstrated that CRT is effective in heart failure (HF) patients who are in SR, but no trials have addressed whether CRT confers similar benefits in AF patients, with or without AVJA.”

The study compared clinical outcomes of patients with permanent AF undergoing CRT combined with either AVJA (n = 443) or rate-slowing drugs (n = 895) to outcomes in patients who were in SR (n = 6,046).

The study found that after median follow-up of 37 months: all-cause (6.8 vs 6.1 per 100 person year) and cardiac-related mortality (4.2 vs 4.0) were similar in patients with atrial fibrillation and AVJA and in patients who were in SR (both p = NS).

In contrast, the atrial fibrillation plus rate-slowing drugs group had a higher rate of total and cardiac-related mortality than both the SR and the atrial fibrillation plus +AVJA groups (11.3 and 8.1, respectively; p<0.001), Gasparini said.

The authors also reported that the atrial fibrillation plus AVJA group had “total (Hazard ratio [HR]: 0.93, 95% confidence interval [C.I.] 0.74-1.67) and cardiac mortality (HR: 0.88, 95% C.I. 0.66-1.17) similar to the SR group, independent of known confounders.”

The atrial fibrillation plus rate-slowing drugs group, however, “had a higher total (HR: 1.52, 95% C.I. 1.26-1.82) and cardiac (HR: 1.57, 95% C.I. 1.27-1.94) mortality than both the SR and AF+AVJA groups (both p<0.001),” according to the study authors.

They concluded that “Long term survival after CRT in patients with AF+AVJA is similar to that observed in patients in SR. Mortality is higher in AF patients treated with rate-slowing drugs.”