[CRT-FORUM] 22E. AF, HF and CRT. Dr. Steinberg

[CRT-INFO]

With the exception of a small substudy of MUSTIC, patients with AF and 
the usual criteria for CRT have not been included in randomized clinical 
trials. Some published observational studies suggest a similar benefit 
for AF patients as for patients with sinus rhythm. However, other 
studies raise some cautions and suggest that many AF patients do not 
respond,  possibly due to ineffective pacing, and instead AF patients 
may require extra-ordinary steps to achieve rate control, including at 
times AV junction ablation. For these reasons, it is reasonable to 
implant CRT at present, but keep in mind the caveats described above. 
Ideally, this population deserves a independent assessment in a 
randomized clinical trial, not only to prove benefit, but to quantify 
the frequency and magnitude of benefit, and potential special efforts to 
achieve clinical response.

Jon Steinberg
> AF is a major issue in HF patiens and its presence may interfere with 
> optimal delivery of CRT.  Do you think that up today, this is a clear 
> indication for implantation or it must be assesed in randomized 
> clinical trials?
> Kenneth Woolfe, MD
> Oakland, Ca
>


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee