Journal article
Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies
Open heart, Vol.6(1), pp.e000937-e000937
03/2019
DOI: 10.1136/openhrt-2018-000937
PMCID: PMC6546263
PMID: 31217991
Abstract
BackgroundCardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF)Methods and resultsLiterature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).ConclusionThe results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.
Details
- Title: Subtitle
- Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies
- Creators
- Usman Mustafa - Louisiana State University Health Sciences Center ShreveportJessica Atkins - Louisiana State University Health Sciences Center ShreveportGeorge Mina - Louisiana State University Health Sciences Center ShreveportDesiree Dawson - Louisiana State University Health Sciences Center ShreveportCatherine Vanchiere - Louisiana State University Health Sciences Center ShreveportNarendra Duddyala - Louisiana State University Health Sciences Center ShreveportRyan Jones - Louisiana State University Health Sciences Center ShreveportPratap Reddy - Louisiana State University Health Sciences Center ShreveportPaari Dominic - Louisiana State University Health Sciences Center Shreveport
- Resource Type
- Journal article
- Publication Details
- Open heart, Vol.6(1), pp.e000937-e000937
- DOI
- 10.1136/openhrt-2018-000937
- PMID
- 31217991
- PMCID
- PMC6546263
- NLM abbreviation
- Open Heart
- ISSN
- 2053-3624
- eISSN
- 2053-3624
- Grant note
- name: National Institute of General Medical Sciences of the National Institutes of Health, award: 2 U54 GM104940-02
- Language
- English
- Date published
- 03/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984367139902771
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