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.

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. - ISSN 1388-9842. - 20:10(2018), pp. 1472-1481. [10.1002/ejhf.1117]

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

Boriani, Giuseppe
2018

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.
18-dic-2017
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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. - ISSN 1388-9842. - 20:10(2018), pp. 1472-1481. [10.1002/ejhf.1117]
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
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1167954
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