Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?

Ana Abreu, Mário Oliveira, Pedro Silva Cunha, Helena Santa Clara, Guilherme Portugal, Inês Gonçalves Rodrigues, Vanessa Santos, Luis Morais, Mafalda Selas, Rui Soares, Luísa Branco, Rui Ferreira, Miguel Mota Carmo

Research output: Contribution to journalArticle

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Abstract

Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device. Results: All patients achieved ≥95% biventricular pacing, and 5.7% underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71% vs. 39% in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases. Conclusion: Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010).

Original languageEnglish
Pages (from-to)687-694
Number of pages8
JournalRevista Portuguesa de Cardiologia
Volume36
Issue number10
DOIs
Publication statusPublished - Oct 2017

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Cardiac Resynchronization Therapy
Atrial Fibrillation
Heart Failure
Exercise Test
Cardiac Resynchronization Therapy Devices
Atrial Remodeling
Left Ventricular Function
Oxygen Consumption
Stroke Volume

Keywords

  • Atrial fibrillation
  • Cardiac resynchronization
  • Heart failure
  • Responder

Cite this

Abreu, Ana ; Oliveira, Mário ; Silva Cunha, Pedro ; Santa Clara, Helena ; Portugal, Guilherme ; Gonçalves Rodrigues, Inês ; Santos, Vanessa ; Morais, Luis ; Selas, Mafalda ; Soares, Rui ; Branco, Luísa ; Ferreira, Rui ; Mota Carmo, Miguel. / Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?. In: Revista Portuguesa de Cardiologia. 2017 ; Vol. 36, No. 10. pp. 687-694.
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abstract = "Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device. Results: All patients achieved ≥95{\%} biventricular pacing, and 5.7{\%} underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71{\%} vs. 39{\%} in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases. Conclusion: Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010).",
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Abreu, A, Oliveira, M, Silva Cunha, P, Santa Clara, H, Portugal, G, Gonçalves Rodrigues, I, Santos, V, Morais, L, Selas, M, Soares, R, Branco, L, Ferreira, R & Mota Carmo, M 2017, 'Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?', Revista Portuguesa de Cardiologia, vol. 36, no. 10, pp. 687-694. https://doi.org/10.1016/j.repc.2017.02.016

Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients? / Abreu, Ana; Oliveira, Mário; Silva Cunha, Pedro; Santa Clara, Helena; Portugal, Guilherme; Gonçalves Rodrigues, Inês; Santos, Vanessa; Morais, Luis; Selas, Mafalda; Soares, Rui; Branco, Luísa; Ferreira, Rui; Mota Carmo, Miguel.

In: Revista Portuguesa de Cardiologia, Vol. 36, No. 10, 10.2017, p. 687-694.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does permanent atrial fibrillation modify response to cardiac resynchronization therapy in heart failure patients?

AU - Abreu, Ana

AU - Oliveira, Mário

AU - Silva Cunha, Pedro

AU - Santa Clara, Helena

AU - Portugal, Guilherme

AU - Gonçalves Rodrigues, Inês

AU - Santos, Vanessa

AU - Morais, Luis

AU - Selas, Mafalda

AU - Soares, Rui

AU - Branco, Luísa

AU - Ferreira, Rui

AU - Mota Carmo, Miguel

PY - 2017/10

Y1 - 2017/10

N2 - Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device. Results: All patients achieved ≥95% biventricular pacing, and 5.7% underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71% vs. 39% in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases. Conclusion: Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010).

AB - Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device. Results: All patients achieved ≥95% biventricular pacing, and 5.7% underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71% vs. 39% in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases. Conclusion: Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010).

KW - Atrial fibrillation

KW - Cardiac resynchronization

KW - Heart failure

KW - Responder

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DO - 10.1016/j.repc.2017.02.016

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