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Outcomes of cardiac resynchronisation therapy in patients with heart failure with atrial fibrillation: a systematic review and meta-analysis of observational studies
- Source :
- Open Heart
- Publication Year :
- 2019
- Publisher :
- BMJ Publishing Group, 2019.
-
Abstract
- BackgroundCardiac resynchronisation therapy (CRT) is beneficial in selected patients with heart failure (HF) in normal sinus rhythm (NSR). We sought to evaluate the impact of CRT with or without atrioventricular junction (AVJ) ablation in patients with HF with concomitant atrial fibrillation (AF)Methods and resultsLiterature was searched (inception through 30 August 2017) for observational studies that reported outcomes in patients with HF with CRT and AF that reported all-cause and cardiovascular mortality. Thirty-one studies with 83, 571 patients were included. CRT did not decrease mortality compared with internal cardioverter defibrillator or medical therapy alone in patients with HF and AF with indications for CRT (OR: 0.851, 95% CI 0.616 to 1.176, p=0.328, I2=86.954). CRT-AF patients had significantly higher all-cause and cardiovascular mortality than CRT-NSR patients ([OR: 1.472, 95% CI 1.301 to 1.664, p=0.000] and [OR: 1.857, 95% CI 1.350 to 2.554, p=0.000] respectively). Change in left ventricular ejection fraction was not different between CRT patients with and without AF (p=0.705). AVJ ablation, however, improved all-cause mortality in CRT-AF patients when compared with CRT-AF patients without AVJ ablation (OR: 0.485, 95% CI 0.247 to 0.952, p=0.035). With AVJ ablation, there was no difference in all-cause mortality in CRT-AF patients compared with CRT-NSR patients (OR: 1.245, 95% CI 0.914 to 1.696, p=0.165).ConclusionThe results of our meta-analysis suggest that AF was associated with decreased CRT benefits in patients with HF. CRT, however, benefits patients with AF with AVJ ablation.
- Subjects :
- medicine.medical_specialty
genetic structures
medicine.medical_treatment
biventricular pacing
implanted cardioverter defibrillator
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
In patient
030212 general & internal medicine
cardiovascular diseases
Heart Failure and Cardiomyopathies
ejection fraction
Ejection fraction
business.industry
Atrial fibrillation
atrioventricular junction ablation
medicine.disease
Ablation
3. Good health
Concomitant
Heart failure
Meta-analysis
Cardiology
cardiovascular system
Observational study
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 20533624
- Volume :
- 6
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Open Heart
- Accession number :
- edsair.doi.dedup.....e30c50f6a8bc3b2fb4d54250358705b8