Impact of atrioventricular junction ablation and CRT‐D on long‐term mortality in patients with left ventricular dysfunction, permanent, refractory atrial fibrillation, and narrow QRS: Results of a propensity‐matched analysis.

Introduction: In patients with symptomatic permanent atrial fibrillation (PEAF) and narrow QRS, atrio‐ventricular junction ablation (AVJA) plus cardiac resynchronization therapy (CRT) is superior to medical therapy in reducing heart failure (HF) hospitalization and all‐cause mortality. To compare the mortality of a population of patients with HF, reduced EF (rEF), and PEAF treated with AVJA plus CRT with that of a contemporary cohort of patients in sinus rhythm (SR) with similar baseline characteristics. Methods and Results: In this prospective, multicentre, observational study, all‐cause mortality in a group of consecutive patients undergoing AVJA and implantable cardioverter‐defibrillator (ICD) combined with CRT implantation for HFrEF, narrow QRS, and PEAF with uncontrolled ventricular rate was compared with that of a contemporary cohort of patients in SR undergoing ICD implantation (not combined with CRT) for HFrEF and narrow QRS. Individual 1:1 propensity matching of baseline characteristics was performed. A total of 824 patients were enrolled. Propensity matching yielded 107 matched pairs. After a median follow‐up of 52 months, all‐cause mortality was similar in patients treated with AVJA plus CRT and in the control group (p =.434). In AVJA plus CRT patients, mortality was significantly lower than in control group patients with a history of paroxysmal/persistent AF (n = 45, p =.020), and similar to that of patients without a history of AF (n = 62, p =.459). Conclusions: After adjustment for patient characteristics, the long‐term prognosis of patients with HFrEF, narrow QRS, and PEAF who underwent AVJA plus CRT was similar to that of a population of patients in SR with similar characteristics. [ABSTRACT FROM AUTHOR]