Role of AV Nodal Ablation in Cardiac Resynchronization in Patients With Coexistent Atrial Fibrillation and Heart Failure A Systematic Review

被引：134

作者：

Ganesan, Anand N. ^{[2
]}

Brooks, Anthony G. ^{[2
]}

Roberts-Thomson, Kurt C. ^{[2
]}

Lau, Dennis H. ^{[2
]}

Kalman, Jonathan M. ^{[3
,4
]}

Sanders, Prashanthan ^{[1
,2
]}

机构：

[1] Royal Adelaide Hosp, Dept Cardiol, Ctr Heart Rhythm Disorders, Adelaide, SA 5000, Australia

[2] Univ Adelaide, Ctr Heart Rhythm Disorders, Adelaide, SA, Australia

[3] Royal Melbourne Hosp, Dept Cardiol, Melbourne, Vic, Australia

[4] Univ Melbourne, Dept Med, Melbourne, Vic, Australia

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 59卷 / 08期

基金：

英国医学研究理事会;

关键词：

atrial fibrillation; biventricular pacing; cardiac resynchronization; heart failure; systematic review; ATRIOVENTRICULAR JUNCTION ABLATION; SINUS RHYTHM; RESYNCHRONISATION THERAPY; MORTALITY; SURVIVAL; BENEFITS;

D O I：

10.1016/j.jacc.2011.10.891

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to systematically review the medical literature to evaluate the impact of AV nodal ablation in patients with heart failure and coexistent atrial fibrillation (AF) receiving cardiac resynchronization therapy (CRT). Background CRT has a substantial evidence base in patients in sinus rhythm with significant systolic dysfunction, symptomatic heart failure, and prolonged QRS duration. The role of CRT is less well established in AF patients with coexistent heart failure. AV nodal ablation has recently been suggested to improve outcomes in this group. Methods Electronic databases and reference lists through September 15, 2010, were searched. Two reviewers independently evaluated citation titles, abstracts, and articles. Studies reporting the outcomes after AV nodal ablation in patients with AF undergoing CRT for symptomatic heart failure and left ventricular dyssynchrony were selected. Data were extracted from 6 studies, including 768 CRT-AF patients, composed of 339 patients who underwent AV nodal ablation and 429 treated with medical therapy aimed at rate control alone. Results AV nodal ablation in CRT-AF patients was associated with significant reductions in all-cause mortality (risk ratio: 0.42 [95% confidence interval: 0.26 to 0.68]), cardiovascular mortality (risk ratio: 0.44 [95% confidence interval: 0.24 to 0.81]), and improvement in mean New York Heart Association functional class (risk ratio: -0.52 [95% confidence interval: -0.87 to -0.17]). Conclusions AV nodal ablation was associated with a substantial reduction in all-cause mortality and cardiovascular mortality and with improvements in New York Heart Association functional class compared with medical therapy in CRT-AF patients. Randomized controlled trials are warranted to confirm the efficacy and safety of AV nodal ablation in this patient population. (J Am Coll Cardiol 2012; 59:719-26) (C) 2012 by the American College of Cardiology Foundation

引用

页码：719 / 726

页数：8

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