Cardiologia Croatica, Vol. 12 No. 5-6, 2017.
Review article
https://doi.org/10.15836/ccar2017.254
Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options.
Dubravko Petrač
; «Bogdan» Outpatient Cardiology Clinic, Zagreb, Croatia
Abstract
Atrial fibrillation (AF) is often present in patients with cardiac resynchronization therapy (CRT), and may have a significant negative impact on the prognosis and CRT response. Management of AF in CRT patients includes the optimal pharmacological heart failure therapy, anticoagulation therapy, and rate or rhythm control therapy with specific goal to ensure a high percentage (≥98%) of biventricular (BiV) pacing. In heart failure patients with AF, a rhythm control with antiarrhythmic drugs has failed to show any survival benefit compared with a rate control drugs. In this context, a rate control with drugs is preferred as first-line therapy in CRT patients with persistent or permanent AF. However, the observational prospective studies and meta-analyses indicate that AV junction ablation is superior to rate control drugs in achieving adequate BiV pacing and reducing mortality. Therefore, an ablation of AV junction should be considered as the first therapeutic choice in CRT patients with permanent AF. Amiodarone and dofetilide are the lone antiarrhythmic drugs suitable for the rhythm control in CRT patients, but with a moderate efficacy and significant side effects. Catheter ablation of AF is another option for the rhythm control, which can improve CRT response by promoting adequate atrioventricular and interventricular synchrony. According to randomized controlled studies in heart failure patients, AF ablation should be considered in CRT patients with paroxysmal AF, who are non-responders to antiarrhythmic drugs, or in selected patients with persistent AF before accepting a rate control therapy.
Keywords
atrial fibrillation; cardiac resynchronization therapy; therapeutic options
Hrčak ID:
185317
URI
Publication date:
17.6.2017.
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