How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond)

Carola Gianni; Luigi Di Biase; Sanghamitra Mohanty; Yalçın Gökoğlan; Mahmut Fatih Güneş; Amin Al-Ahmad; J David Burkhardt; Andrea Natale

doi:10.1016/j.ccep.2015.08.007

How to Improve Cardiac Resynchronization Therapy Benefit in Atrial Fibrillation Patients: Pulmonary Vein Isolation (and Beyond)

Card Electrophysiol Clin. 2015 Dec;7(4):755-64. doi: 10.1016/j.ccep.2015.08.007.

Authors

Carola Gianni¹, Luigi Di Biase², Sanghamitra Mohanty³, Yalçın Gökoğlan³, Mahmut Fatih Güneş³, Amin Al-Ahmad³, J David Burkhardt³, Andrea Natale⁴

Affiliations

¹ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA.
⁴ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 North IH-35, Suite 700, Austin, TX 78705, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA; Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA. Electronic address: dr.natale@gmail.com.

PMID: 26596817
DOI: 10.1016/j.ccep.2015.08.007

Abstract

Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.

Keywords: Atrial fibrillation; Cardiac resynchronization therapy; Catheter ablation; Heart failure; Pulmonary vein ablation; Triggers.

Publication types

Review

MeSH terms

Anti-Arrhythmia Agents / therapeutic use
Atrial Fibrillation / mortality*
Atrial Fibrillation / surgery*
Cardiac Resynchronization Therapy / mortality
Cardiac Resynchronization Therapy / statistics & numerical data*
Catheter Ablation / mortality
Catheter Ablation / statistics & numerical data
Combined Modality Therapy / mortality
Combined Modality Therapy / statistics & numerical data
Comorbidity
Evidence-Based Medicine
Heart Conduction System / surgery
Heart Failure / mortality*
Heart Failure / prevention & control*
Humans
Prevalence
Pulmonary Veins / surgery*
Risk Factors
Survival Rate
Treatment Outcome

Substances

Anti-Arrhythmia Agents