Atrial fibrillation in cardiac resynchronization therapy

Mark K Elliott; Vishal S Mehta; Dejana Martic; Baldeep S Sidhu; Steven Niederer; Christopher A Rinaldi

doi:10.1016/j.hroo.2021.09.003

Atrial fibrillation in cardiac resynchronization therapy

Heart Rhythm O2. 2021 Dec 17;2(6Part B):784-795. doi: 10.1016/j.hroo.2021.09.003. eCollection 2021 Dec.

Authors

Mark K Elliott^{1

2}, Vishal S Mehta^{1

2}, Dejana Martic², Baldeep S Sidhu^{1

2}, Steven Niederer¹, Christopher A Rinaldi^{1

2}

Affiliations

¹ School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
² Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Abstract

Patients with atrial fibrillation (AF) were largely excluded from the major clinical trials of cardiac resynchronization therapy (CRT), despite the presence of AF in up to 40% of patients receiving CRT in clinical practice. AF appears to attenuate the response to CRT, by the combination of a reduction in biventricular pacing and the loss of atrioventricular synchrony. In addition, remodeling secondary to CRT may influence the progression of AF. Management options for patients with AF and CRT include rate control, with drugs or atrioventricular node ablation, or rhythm control, with electrical cardioversion and antiarrhythmic therapy, or AF catheter ablation. The evidence for these therapies in patients with CRT is largely limited to observational studies or inferred from randomized studies in the general heart failure population. In this review, we explore the complex interaction between AF, heart failure, and CRT and discuss the evidence for the treatment options in this difficult patient cohort.

Keywords: AF ablation; AV node ablation; Atrial fibrillation; Cardiac resynchronization therapy; Pulmonary vein isolation; Rate control; Rhythm control.

Grants and funding

R01 HL152256/HL/NHLBI NIH HHS/United States