Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations

Maurizio Gasparini, Axel Kloppe, Maurizio Lunati, Frédéric Anselme, Maurizio Landolina, Jose Bautista Martinez-Ferrer, Alessandro Proclemer, Giovanni Morani, Mauro Biffi, Renato Ricci, Roberto Rordorf, Lorenza Mangoni, Laura Manotta, Andrea Grammatico, Francisco Leyva, Giuseppe Boriani

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

AIMS: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs.

METHODS AND RESULTS: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF + AVJA) and 402 (12%) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027].

CONCLUSION: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.

CLINICAL TRIAL REGISTRATION: NCT00147290, NCT00617175, NCT01007474.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusE-pub ahead of print - Dec 18 2017

Fingerprint

Cardiac Resynchronization Therapy
Implantable Defibrillators
Atrial Fibrillation
Cardiac Arrhythmias
Hospitalization
Shock
Pharmaceutical Preparations
Therapeutics
Incidence

Keywords

  • Journal Article

Cite this

Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy : positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations. / Gasparini, Maurizio; Kloppe, Axel; Lunati, Maurizio; Anselme, Frédéric; Landolina, Maurizio; Martinez-Ferrer, Jose Bautista; Proclemer, Alessandro; Morani, Giovanni; Biffi, Mauro; Ricci, Renato; Rordorf, Roberto; Mangoni, Lorenza; Manotta, Laura; Grammatico, Andrea; Leyva, Francisco; Boriani, Giuseppe.

In: European Journal of Heart Failure, 18.12.2017.

Research output: Contribution to journalArticle

Gasparini, Maurizio ; Kloppe, Axel ; Lunati, Maurizio ; Anselme, Frédéric ; Landolina, Maurizio ; Martinez-Ferrer, Jose Bautista ; Proclemer, Alessandro ; Morani, Giovanni ; Biffi, Mauro ; Ricci, Renato ; Rordorf, Roberto ; Mangoni, Lorenza ; Manotta, Laura ; Grammatico, Andrea ; Leyva, Francisco ; Boriani, Giuseppe. / Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy : positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations. In: European Journal of Heart Failure. 2017.
@article{4e2ba88a572c4cea801d7eaabb6cd401,
title = "Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy: positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations",
abstract = "AIMS: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs.METHODS AND RESULTS: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80{\%}) were in sinus rhythm (SR) and 664 (20{\%}) had permanent AF-262 (8{\%}) treated with AVJA (AF + AVJA) and 402 (12{\%}) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95{\%} confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027].CONCLUSION: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.CLINICAL TRIAL REGISTRATION: NCT00147290, NCT00617175, NCT01007474.",
keywords = "Journal Article",
author = "Maurizio Gasparini and Axel Kloppe and Maurizio Lunati and Fr{\'e}d{\'e}ric Anselme and Maurizio Landolina and Martinez-Ferrer, {Jose Bautista} and Alessandro Proclemer and Giovanni Morani and Mauro Biffi and Renato Ricci and Roberto Rordorf and Lorenza Mangoni and Laura Manotta and Andrea Grammatico and Francisco Leyva and Giuseppe Boriani",
note = "{\circledC} 2017 The Authors. European Journal of Heart Failure {\circledC} 2017 European Society of Cardiology.",
year = "2017",
month = "12",
day = "18",
doi = "10.1002/ejhf.1117",
language = "English",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "John Wiley & Sons, Ltd",

}

TY - JOUR

T1 - Atrioventricular junction ablation in patients with atrial fibrillation treated with cardiac resynchronization therapy

T2 - positive impact on ventricular arrhythmias, implantable cardioverter-defibrillator therapies and hospitalizations

AU - Gasparini, Maurizio

AU - Kloppe, Axel

AU - Lunati, Maurizio

AU - Anselme, Frédéric

AU - Landolina, Maurizio

AU - Martinez-Ferrer, Jose Bautista

AU - Proclemer, Alessandro

AU - Morani, Giovanni

AU - Biffi, Mauro

AU - Ricci, Renato

AU - Rordorf, Roberto

AU - Mangoni, Lorenza

AU - Manotta, Laura

AU - Grammatico, Andrea

AU - Leyva, Francisco

AU - Boriani, Giuseppe

N1 - © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

PY - 2017/12/18

Y1 - 2017/12/18

N2 - AIMS: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs.METHODS AND RESULTS: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF + AVJA) and 402 (12%) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027].CONCLUSION: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.CLINICAL TRIAL REGISTRATION: NCT00147290, NCT00617175, NCT01007474.

AB - AIMS: We sought to determine whether atrioventricular junction ablation (AVJA) in patients with cardiac resynchronization therapy (CRT) implantable cardioverter-defibrillator (ICD) and with permanent atrial fibrillation (AF) has a positive impact on ICD shocks and hospitalizations compared with rate-slowing drugs.METHODS AND RESULTS: This is a pooled analysis of data from 179 international centres participating in two randomized trials and one prospective observational research. The co-primary endpoints were all-cause ICD shocks and all-cause hospitalizations. Out of 3358 CRT-ICD patients (2720 male, 66.6 years), 2694 (80%) were in sinus rhythm (SR) and 664 (20%) had permanent AF-262 (8%) treated with AVJA (AF + AVJA) and 402 (12%) treated with rate-slowing drugs (AF + Drugs). Median follow-up was 18 months. The mean (95% confidence intervals) annual rate of all-cause ICD shocks per 100 patient years was 8.0 (5.3-11.9) in AF + AVJA, 43.6 (37.7-50.4) in AF + Drugs, and 34.4 (32.5-36.5) in SR patients, resulting in incidence rate ratio (IRR) reductions of 0.18 (0.10-0.32) for AF + AVJA vs. AF + Drugs (P < 0.001) and 0.48 (0.35-0.66) for AF + AVJA vs. SR (P < 0.001). These reductions were driven by significant reductions in both appropriate ICD shocks [IRR 0.23 (0.13-0.40), P < 0.001, vs. AF + Drugs] and inappropriate ICD shocks [IRR 0.09 (0.04-0.21), P < 0.001, vs. AF + Drugs]. Annual rate of all-cause hospitalizations was significantly lower in AF + AVJA vs. AF + Drugs [IRR 0.57 (0.41-0.79), P < 0.001] and SR [IRR 0.85 (073-0.98), P = 0.027].CONCLUSION: In AF patients treated with CRT, AVJA results in a lower incidence and burden of all-cause, appropriate and inappropriate ICD shocks, as well as to fewer all-cause and heart failure hospitalizations.CLINICAL TRIAL REGISTRATION: NCT00147290, NCT00617175, NCT01007474.

KW - Journal Article

U2 - 10.1002/ejhf.1117

DO - 10.1002/ejhf.1117

M3 - Article

C2 - 29251799

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

ER -