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22-11-2011 | Cardiology | Article

Ablate and pace yields significant benefit in RV-, CRT-paced patients


Free abstract

MedWire News: "Ablate and pace" therapy yields a significant clinical benefit in right ventricular (RV)-paced patients and cardiac resynchronization therapy (CRT)-paced patients, study findings suggest.

CRT-pacing mode and echo-optimized CRT were the only independent predictors of clinical benefit, report Michele Brignole (Ospedali del Tigullio, Lavagna, Italy) and co-authors in the journal Heart.

Their analysis involved 171 patients enrolled in the multicenter Ablate and Pace in Atrial Fibrillation (APAF) trial who had drug-refractory severely symptomatic permanent atrial fibrillation (AF) and underwent atrioventricular (AV) junction ablation.

Patients were randomly allocated to undergo CRT pacing or RV pacing and were followed-up for a median of 20 months.

Overall, 125 (73%) patients showed a clinical improvement after ablate and pace therapy, and were known as "responders," while 46 (27%) showed no clinical improvement, known as "nonresponders." Overall, 63% of the RV-pacing group and 83% of the CRT-pacing group were responders (p=0.003)

Multivariate analysis showed that CRT mode and echo-optimized CRT were independent protective factors against nonresponse, at hazard ratios of 0.24 and 0.22, respectively (p=0.001 and p=0.018).

On comparing freedom from nonresponse, echo-optimized CRT, but not simultaneous biventricular pacing, proved superior to RV pacing. There was also a trend in favor of echo-optimized CRT versus biventricular pacing, the authors write.

"Ablate and pace was at least as useful in patients with less severe cases as in patients with more advanced heart failure, that is, those meeting the criteria for CRT therapy set out in the most recent American and European guidelines," they say.

"Indications for CRT should be considered in all patients with severely symptomatic AF undergoing AV junction ablation as no clinical difference was observed in the outcome of the patients who met the current guideline indications and those who did not."

"However, considering the higher costs and complications of CRT an alternative strategy of CT upgrading may be a reasonable clinical option in patients who, for any reason, were initially paced at the RV only," conclude Brignole and team.

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By Piriya Mahendra

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