A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS

APAF-CRT Investigators

Research output: Contribution to journalArticle

Abstract

Aims: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS.

Methods and results: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004).

Conclusion: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS.

ClinicalTrials.gov Identifier: NCT02137187 (May 2018, date last accessed).

Original languageEnglish
Pages (from-to)3999-4008
Number of pages10
JournalEuropean Heart Journal
Volume39
Issue number45
DOIs
Publication statusPublished - Dec 1 2018
Externally publishedYes

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Cardiac Resynchronization Therapy
Atrial Fibrillation
Randomized Controlled Trials
Heart Failure
Hospitalization
Defibrillators
Pharmacology
Confidence Intervals
Guidelines
Pharmaceutical Preparations
Therapeutics
Quality of Life

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A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS. / APAF-CRT Investigators .

In: European Heart Journal, Vol. 39, No. 45, 01.12.2018, p. 3999-4008.

Research output: Contribution to journalArticle

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abstract = "Aims: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS.Methods and results: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20{\%}) in the Ablation+CRT arm and in 20 patients (38{\%}) in the Drug arm [hazard ratio (HR) 0.38; 95{\%} confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12{\%}) vs. 17 (33{\%}); HR 0.28; 95{\%} CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10{\%}) vs. 13 (25{\%}); HR 0.30; 95{\%} CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36{\%} decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004).Conclusion: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS.ClinicalTrials.gov Identifier: NCT02137187 (May 2018, date last accessed).",
author = "{APAF-CRT Investigators} and Michele Brignole and Evgeny Pokushalov and Francesco Pentimalli and Pietro Palmisano and Enrico Chieffo and Eraldo Occhetta and Fabio Quartieri and Leonardo Cal{\`o} and Andrea Ungar and Lluis Mont",
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T1 - A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS

AU - APAF-CRT Investigators

AU - Brignole, Michele

AU - Pokushalov, Evgeny

AU - Pentimalli, Francesco

AU - Palmisano, Pietro

AU - Chieffo, Enrico

AU - Occhetta, Eraldo

AU - Quartieri, Fabio

AU - Calò, Leonardo

AU - Ungar, Andrea

AU - Mont, Lluis

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Aims: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS.Methods and results: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004).Conclusion: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS.ClinicalTrials.gov Identifier: NCT02137187 (May 2018, date last accessed).

AB - Aims: We tested the hypothesis that atrioventricular (AV) junction ablation in conjunction biventricular pacing [cardiac resynchronization (CRT)] pacing is superior to pharmacological rate-control therapy in reducing heart failure (HF) and hospitalization in patients with permanent atrial fibrillation (AF) and narrow QRS.Methods and results: We randomly assigned 102 patients (mean age 72 ± 10 years) with severely symptomatic permanent AF (>6 months), narrow QRS (≤110 ms), and at least one hospitalization for HF in the previous year to AV junction ablation and CRT (plus defibrillator according to guidelines) or to pharmacological rate-control therapy (plus defibrillator according to guidelines). After a median follow-up of 16 months, the primary composite outcome of death due to HF, or hospitalization due to HF, or worsening HF had occurred in 10 patients (20%) in the Ablation+CRT arm and in 20 patients (38%) in the Drug arm [hazard ratio (HR) 0.38; 95% confidence interval (CI) 0.18-0.81; P = 0.013]. Significantly fewer patients in the Ablation+CRT arm died from any cause or underwent hospitalization for HF [6 (12%) vs. 17 (33%); HR 0.28; 95% CI 0.11-0.72; P = 0.008], or were hospitalized for HF [5 (10%) vs. 13 (25%); HR 0.30; 95% CI 0.11-0.78; P = 0.024]. In comparison with the Drug arm, Ablation+CRT patients showed a 36% decrease in the specific symptoms and physical limitations of AF at 1 year follow-up (P = 0.004).Conclusion: Ablation+CRT was superior to pharmacological therapy in reducing HF and hospitalization and improving quality of life in elderly patients with permanent AF and narrow QRS.ClinicalTrials.gov Identifier: NCT02137187 (May 2018, date last accessed).

U2 - 10.1093/eurheartj/ehy555

DO - 10.1093/eurheartj/ehy555

M3 - Article

C2 - 30165479

VL - 39

SP - 3999

EP - 4008

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 45

ER -