Cardiac resynchronization therapy in the presence of total atrioventricular block reduces long-lasting atrial fibrillation episodes

Lara Kugler; Susanne Markendorf; Marta Bachmann; Urs Eriksson

doi:10.1002/joa3.12776

Cardiac resynchronization therapy in the presence of total atrioventricular block reduces long-lasting atrial fibrillation episodes

J Arrhythm. 2022 Sep 7;38(5):723-729. doi: 10.1002/joa3.12776. eCollection 2022 Oct.

Authors

Lara Kugler^{1

2}, Susanne Markendorf^{2

3}, Marta Bachmann^{1

2}, Urs Eriksson^{1

2

3}

Affiliations

¹ Division of Cardiology GZO - Zurich Regional Health Centre Wetzikon Switzerland.
² University of Zurich Zurich Switzerland.
³ Heart Center Zurich, Division of Cardiology and Electrophysiology Zurich University Hospital Zurich Switzerland.

Abstract

Background: There is an ongoing debate on how cardiac resynchronization therapy (CRT) in the presence of total AV block affects atrial fibrillation (AF) episodes and symptoms in patients with AF.

Methods: Seventy-five patients with symptomatic, drug and ablation refractory AF received, irrespective of their left ventricular ejection fraction (EF), either a CRT device and underwent subsequent atrioventricular node (AVN) ablation or already had a total AV block and underwent CRT upgrade. Long-lasting AF episodes (>48 h), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD), NTproBNP levels, EHRA score, and NYHA class had been monitored on the follow-up.

Results: The number of patients experiencing long-lasting AF episodes (>48 h) and symptoms decreased significantly within 24 months after CRT implantation in the presence of total AV block (p < .001) from 57 (76%) to 25 (33.3%). Mean LAD decreased from 52 mm (IQR 48.0-56.0) to 48 mm (IQR 42.0-52.0, p < .001) and LVEDD from 54 mm (IQR 49.0-58.0) to 51 mm (IQR 46.5-54.0, p < .001).

Conclusion: A combination of total AVN block and biventricular pacing markedly reduces long-lasting AF episodes, symptoms, left atrial diameter, and left ventricular end-diastolic diameter.

Keywords: CRT; atrial fibrillation; atrial fibrillation episodes; atrioventricular node ablation; reverse remodeling.