Clinical researchAssociation of Rate-Controlled Persistent Atrial Fibrillation With Clinical Outcome and Ventricular Remodelling in Recipients of Cardiac Resynchronization Therapy
Section snippets
Patient population
This report is a post hoc analysis of data from the Effect of Targeting Left Ventricular Lead Position on the Rate of Response to CRT study (INCREMENTAL; ClinicalTrials.gov identifier NCT00399594). INCREMENTAL was a pilot randomized trial comparing LV lead placement targeted to the latest-activated segment on preprocedure tissue-Doppler echocardiography with standard lead positioning. Enrollment criteria included New York Heart Association (NYHA) class 3 or 4 limitation due to heart failure, LV
Results
The study enrolled 96 patients between December 2004 and March 2007. Of these, 3 patients did not have successful CRT implantation and were excluded. A further 7 patients died (4 of heart failure and 1 of noncardiac causes) or underwent cardiac transplant (n = 2) prior to the 2-month follow-up visit and were included for survival analysis but excluded from analyses of CRT response. One of these patients had AF at baseline. The remaining 86 patients had complete follow-up, with vital status
Discussion
Using a composite of symptomatic improvement and LV reverse remodelling, we find that patients with and without rate-controlled persistent AF have a similar likelihood of responding to CRT in the first year of treatment. In fact, symptomatic benefit was sustained for 1 year in at least 70% of patients in both groups, with parallel improvements in 6MWD and health-related QOL. However, those in the persistent AF group had significantly less improvement in LVESV, despite the fact that they were a
Funding Sources
The study was funded by the Canadian Institutes of Health Research (CIHR). Additional unrestricted grants in aid were received from Medtronic of Canada and Roche Diagnostics. Dr Wilton is funded by the CIHR Randomized Controlled Trials Mentoring Program, Ottawa. Dr Exner is a Scholar of the Alberta Heritage Foundation for Medical Research.
Disclosures
Dr Yee is a consultant to and is the recipient of research grants from Medtronic Inc. Dr Exner has received honouraria and research support from Medtronic and St Jude Medical, honouraria from Boston Scientific, and research support from Sorin/ELA.
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